Adherence to evidence-based guidelines for the management of candiduria in a tertiary care center in Riyadh: A retrospective cross-sectional study

According to the Infectious Disease Society of America (IDSA) 2016 guidelines for the management of candidiasis, the presence of Candida in the urine in asymptomatic patients is usually a colonization rather than an infection, which does not require antifungals treatment. This study aims to assess the management of candiduria at a tertiary hospital in Riyadh, Saudi Arabia, in comparison to IDSA guidelines and its impact on patient outcomes. This was a single-center, retrospective, cross-sectional study conducted at a tertiary care center in Riyadh, Saudi Arabia. All adult hospitalized patients (≥ 18 years old) who had a positive urine culture for a Candida species from Jan 2023 to Dec 2023 were included in the study. All Patients' data were extracted from electronic health records. IRB approval (E-23-8172) was granted. A total of 217 urine cultures that were positive for a Candida species were included in our study. 166 (76.5%) candiduria episodes were managed in accordance with the IDSA recommendations, while 51 (23.5%) were treated against these recommendations. Urinary symptoms were present significantly more in those who were treated against IDSA recommendations (4.2% vs 74.5%, P < 0.00001). The in-hospital mortality rate (36.7% vs 29.4%, P = 0.34) did not differ significantly between the two groups. This study showed that around 77% of candiduria patients were managed according to the IDSA guidelines. However, while the degree of adherence to the guidelines was high in asymptomatic patients, most of the symptomatic patients were managed inappropriately. Adherence to the guidelines' recommendations did not significantly affect patients' outcomes.