Clinical Impact of Treating Versus Not Treating Asymptomatic Bacteriuria/Candiduria in the First Two Months After Kidney Transplantation

Background/Objectives: The management of asymptomatic bacteriuria (ASB) and candiduria (ASC) in kidney transplant recipients during the early post-transplant period is controversial. This study aimed to evaluate whether treating, versus not treating, ASB and ASC episodes in the first two months after kidney transplantation influences clinical outcomes and the emergence of multidrug-resistant (MDR) infections. Methods: We conducted a single-center retrospective cohort study enrolling patients with ASB or ASC occurring in the first two months after kidney transplantation between January 2019 and July 2024. Patients were classified into treated and untreated groups. The primary endpoint was 30-day mortality. Secondary endpoints included mortality at 90, 180 and 360 days; incidence of sepsis or septic shock; bacteremia/candidemia, hospitalization, graft loss; decline in renal function, urinary tract infections (UTIs), recurrent UTI and rate of MDR colonization/infection. Results: We enrolled 59 kidney transplant recipients and observed 147 episodes of ASB/ASC. Of the 147 episodes, 95 were untreated and 52 were treated. No significant differences were observed between treated and untreated patients in 30-day (2.1% vs. 3.8%) or 90-day mortality (2.1% vs. 1.9%), nor in any of the secondary clinical outcomes. However, patients who received treatment tended to have a higher rate of MDR colonization/infection (63% vs. 46%). MDR pathogen isolation was significantly associated with increased risks of septic shock (OR 4.639, p = 0.04), bacteremia/candidemia (OR 3.734, p = 0.01), hospitalization (OR 2.183, p = 0.03) and renal function deterioration (OR 3.93, p = 0.03). Conclusions: Antimicrobial treatment of ASB and ASC in the early post-transplant period would seem not to confer clinical benefit and may be associated with the risk of MDR colonization/infection.