Overtreatment of Asymptomatic Candiduria among Hospitalized Patients: A Multi-institutional Study [PublishAheadOfPrint]

Candiduria is common in hospitalized patients and asymptomatic candiduria contributes to antifungal overuse. Guidelines for asymptomatic candiduria do not recommend antifungal use, rather the elimination of predisposing factors. It is unknown whether these recommendations are being followed. The primary objective of this study was to characterize candiduria management among hospitalized patients. This was a retrospective cohort study of a random sample of 305 hospitalized patients with candiduria at four U.S. medical centers from January 2010 to December 2013. Patients were classified as asymptomatic or symptomatic based on established criteria and data were collected by chart review. IDSA treatment guideline adherence and its association with clinical outcomes including candiduria recurrence (short- and long-term) and 30-day readmission were assessed. Eighty percent of patients were classified asymptomatic candiduria. Overall, 143 (47%) patients were not managed according to guidelines including 105/243 (43%) in the asymptomatic candiduria group and 38/62 (61%) in the symptomatic group (p=0.01). Discordance among asymptomatic patients was driven by overtreatment with an antifungal (98/105, 93%). Thirty-three percent of patients with asymptomatic candiduria not managed according to guidelines were treated for over 7 days, and 5% received over 14 days of therapy. Fluconazole was the most commonly used empiric antifungal among asymptomatic candiduria patients (96%) followed by micafungin (4%). Asymptomatic candiduria patients not managed according to guidelines had a trend toward higher 30-day readmission (35% vs. 26%, p=0.27). Inappropriate management of candiduria among hospitalized patients was high, leading to over-treatment with antifungal therapy.

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