Evaluation of shorter versus longer antifungal treatment durations for Candida spp. urinary tract infections among hospitalized adults.

Infectious Diseases Society of America guidelines recommend 14 days of treatment for Candida spp. urinary tract infections (UTIs). To our knowledge, no data are available to compare <14 days for Candida spp. UTI. This was a single-center, retrospective cohort study between 01 January 2015 and 01 January 2024. Hospitalized adults with >1 urine culture with Candida spp. and symptoms who initiated >1 antifungal dose within 96 hours were included. Multiple exclusion criteria existed, including but not limited to if Candida spp. were isolated from another site, antifungals were received for another indication, or the participant was asymptomatic. The primary outcome was clinical treatment success. Binary logistic regression was performed to further assess the relationship between fluconazole duration and clinical treatment success. Among 2,400 patients with candiduria, 45 and 58 in the 14-day and <14-day cohorts were assessed after exclusion criteria were applied, respectively. Median (interquartile range) fluconazole duration was 14 (14-14) days in the 14-day cohort and 7 (5-7) in the <14-day cohort. There was no difference in clinical treatment success in patients treated for 14 days vs <14 days (14 days: 93.3% (42/45) vs <14 days: 93.1% (54/58), P = 1.000; between-group difference (95% CI: 0.02 [-9.6 to 10]). Fluconazole duration did not have a significant association with clinical treatment success on binary logistic regression (P = 0.503; odds ratio 0.917 [95% CI: 0.712-1.181]). There was no statistically significant difference in clinical treatment success in patients treated with fluconazole for a median of 14 days vs a median of 7 days for symptomatic Candida spp. UTI. These data support the potential utility of shorter antifungal durations for Candida spp. UTI.