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Program

Infectious Diseases

Training Level

Fellow

Institution

Henry Ford Hospital

Abstract

Background: Candidemia is associated with a 30-day mortality of 20-40%, with likelihood of death increasing by 50% for each day therapy is delayed. T2 Candida is approved by the FDA for the diagnosis of candidemia with a sensitivity of 90% and specificity of 98%. The mean time to Candida detection is estimated to be 4.4 hours. Standard blood culture turnaround time is 3 days. Prompt diagnosis is essential to effectively treat candida infection. Methods: Retrospective analyses were conducted on 70 T2MR positive patients. The primary endpoint is time to de-escalation fromechinocandin to fluconazole based on T2 species identified. Secondary endpoints are time to T2 positivity and identification of risk factors for mortality and clinical outcomes of invasive candidiasis (IC).Univariate logistic regression was used to determine association between individual risk factors and primary outcomes. Multivariate Logistic regression models were created using forward selection to model the odds of IC and mortality. Time to de-escalation of echinocandins were modeled using Kaplan-Meier estimators. Results: Univariate analysis showed statistically significant associations between mortality and sepsis diagnosis, hypotension, abnormal WBC count, and tachycardia (P<0.05). Odds of mortality were reduced in patients receiving TPN (OR 0.292, 95% CI 0.097-0.874). Tachycardia, age, and presence of prosthetic devices were the best predictors of mortality (P<0.05). The best predictors of IC were LOS, hypotension, and abnormal WBC count (P <0.05).T2 Testing reduced the turnaround time of test results compared to standard blood cultures from 3 days to <10 hours. In CA/CT positive T2, 50% of patients were de-escalated to Fluconazole therapy in 4 days. CG/CK positive T2 had 50% de-escalation in 20 days. Conclusion: Patient with sepsis, hypotension, abnormal WBC count and tachycardia should raise possibility of IC. T2 testing lowers the turnaround time and allows for timely treatment and de-escalation, compared to standard blood cultures.

Publication Date

5-2019

Impact of T2 Candida Panel on Species Specific Anti-fungal De-escalation

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