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Novel assay reduces time to antifungal therapy for candidemia

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October 25, 2017

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A novel magnetic resonance assay significantly reduced the time to appropriate treatment for candidemia, according to findings published in Journal of Antimicrobial Stewardship.

Candida species are a common cause of nosocomial bloodstream infections and are associated with significant morbidity and an estimated mortality rate between 30% and 50%,” Rachel M. Kenney, PharmD, of the department of pharmacy services at Henry Ford Hospital, Detroit, and colleagues wrote in the journal’s inaugural issue. “Prompt administration of appropriate antifungal therapy is recognized as an important strategy to improve survival of candidemia but may be delayed due to limitations of traditional diagnostic methods.”

Although blood cultures are the current gold standard for diagnosing candidemia, the researchers wrote, cultures may miss as many as half of invasive candidiasis infections and “are limited by their slow time to identification.”

Kenney and colleagues performed a pre-post-test quasi-experimental study of patients with proven or probable candidemia who were treated in a four-hospital health care system between April 1, 2015 and July 31, 2016. Patients in the pre-intervention period were diagnosed by current institutional guidelines (n = 87), whereas those in the intervention phase (n =74) were diagnosed with the T2 magnetic resonance panel (T2 Biosystems).

In the pre-intervention phase, candidemia was most often detected by blood cultures, the researchers wrote (56%), whereas the T2 assay diagnosed 50% of infections during the intervention period. After the introduction of the novel test, median time to appropriate therapy fell from 39 hours to 22, Kenney and colleagues wrote (P = .003). Among the 37 patients diagnosed with the T2 assay, median time to appropriate therapy was 5 hours – an eightfold reduction from blood culture, which during the intervention period had a median 44 hours to appropriate therapy, the researchers reported.

In the pre-intervention group, Candida eye involvement was diagnosed in 30% of patients, compared with 12% in the post-intervention group (P = .028).

Diagnosis with the T2 assay was independently associated with antifungal treatment within 12 hours after the researchers adjusted for severe sepsis (adjusted OR = 5.8; 95% CI, 2.5-13.6). There were no significant differences between groups in mortality or length of stay, Kenney and colleagues wrote.

“This technology has shown it can expedite the detection of candidemia,” Kenney said in a press release accompanying the study. “As a result, patients receive more prompt and appropriate antifungal therapy.” – by Andy Polhamus

Disclosures: Kenney reports no relevant financial disclosures. Please see the study for a full list of all other authors’ relevant financial disclosures.

itj+ Infographic

Median time to appropriate therapy for candidemia was 5 hours in patients diagnosed with the novel T2 assay compared with 44 hours in patients diagnosed with a blood culture test.

itj+ Perspective

Eric Wenzler, PharmD
Perspective

We launched the Journal of Antimicrobial Stewardship to create a forum to highlight the innovative work done by antimicrobial stewardship clinicians and, it is hoped, to accelerate improvements in the field. The management of candidemia is an important issue because the difficulty in diagnosing this condition often leads to a significant delay in time to appropriate therapy, which has been associated with a higher mortality rate. Getting patients on the right therapy quickly is one of the most important factors in improving patient outcomes and advancing stewardship initiatives. Henry Ford’s integration of the T2Candida assay presents an important case study of how faster detection of candidemia can improve patient care through faster treatment and, at the same time, improve stewardship of antimicrobials.

Eric Wenzler, PharmD

Editor, The Journal of Antimicrobial Stewardship

Disclosure: Wenzler reports no relevant financial disclosures.