Department of Infectious Diseases, Hôpital Saint-Louis, AP-HP, Paris, France.
University of Paris Diderot Paris 7, Sorbonne Paris Cité, Paris, France.
Mycoses. 2018 May;61(5):298-304. doi: 10.1111/myc.12740. Epub 2018 Feb 19.
A French single-centre retrospective study between 2010 and 2014 was undertaken to assess candiduria's incidence in kidney transplant recipients (KTR), and the use and impact of antifungal treatment on outcome. Candiduria was defined as a urine culture with ≥10 cfu/mL of Candida species. Candiduria clearance, severe complications and death rates were estimated by Kaplan-Meier methods and the effect of treatment by Cox models. 52/1223 (4.3%) KTR had ≥1 episode of candiduria, 42 (81%) were females, 18 (35%) had diabetes, with an incidence of 2.3/100 person-year of follow-up. Candiduria was asymptomatic in 51 (98%) patients. Candida glabrata was the most frequent pathogen identified. Overall fungal clearance rate was 89%. Antifungal therapy was initiated in only 14 episodes (12%), according to guidelines. Three patients (6%) developed severe complications in the first 2 weeks after transplantation, and 8 (15%) died. Antifungal treatment had no impact on candiduria clearance (HR, 0.6; 95% CI, 0.3-1.1; P = .10), on recurrence rate (HR, 0.5; 95% CI, 0.1-2.3; P = .41) and on the risk of severe complications or death (HR, 1.1; 95% CI, 0.3-4.8; P = .89). Candiduria is rare and usually asymptomatic among KTR. Candiduria management in the immediate post-transplant period deserves careful attention.
一项 2010 年至 2014 年法国单中心回顾性研究评估了肾移植受者（KTR）中念珠菌尿的发生率，以及抗真菌治疗对结局的影响。念珠菌尿定义为尿培养≥10cfu/ml 的念珠菌属。通过 Kaplan-Meier 方法和 Cox 模型估计了念珠菌尿清除率、严重并发症和死亡率，并评估了治疗效果。52/1223（4.3%）例 KTR 有≥1 次念珠菌尿，42 例（81%）为女性，18 例（35%）患有糖尿病，随访期间发病率为 2.3/100 人年。51 例（98%）患者的念珠菌尿无症状。最常见的病原体是光滑念珠菌。总的真菌清除率为 89%。根据指南，仅在 14 例（12%）患者中启动了抗真菌治疗。3 例（6%）患者在移植后 2 周内出现严重并发症，8 例（15%）死亡。抗真菌治疗对念珠菌尿清除率（HR，0.6；95%CI，0.3-1.1；P=0.10）、复发率（HR，0.5；95%CI，0.1-2.3；P=0.41）和严重并发症或死亡风险（HR，1.1；95%CI，0.3-4.8；P=0.89）均无影响。KTR 中念珠菌尿罕见且通常无症状。移植后即刻期的念珠菌尿管理需要仔细关注。
