T2 Candida versus beta-D-glucan to facilitate antifungal discontinuation in the intensive care unit.
Gill CM, Kenney RM, Hencken L, Mlynarek ME, Alangaden GJ, Samuel LP, and Davis SL. T2 Candida versus beta-D-glucan to facilitate antifungal discontinuation in the intensive care unit. Diagn Microbiol Infect Dis 2019; Epub ahead of print.
Diagnostic microbiology and infectious disease
T2 Magnetic Resonance Candida Panel (T2MR) detects Candida directly in blood. Rapid turnaround time and high negative predictive value make it a useful diagnostic test to support antifungal discontinuation. This retrospective quasi-experiment compared empiric anidulafungin days of therapy (DOTs) in intensive care unit (ICU) patients with suspected candidemia that had negative blood cultures and negative 1,3-β-D-glucan (BDG) versus negative blood cultures and negative T2MR. In 206 ICU patients, median anidulafungin DOTs were 2 (1, 5) compared to 1 (1, 2), respectively (P < 0.001); T2MR was associated with early discontinuation, AdjOR 3.0 95% CI (1.7-5.6), P < 0.001. Proven candidemia after discontinuation of anidulafungin occurred in 3% of BDG and 2% of T2MR patients at a median of 8 and 21 days, respectively. T2MR testing supports safe, early discontinuation of empiric antifungal therapy in ICU patients with suspected candidemia. Prospective studies to better define the role of T2MR in antifungal stewardship are warranted.
ePub ahead of print