Utilization of T2Candida Panel for the Rapid Detection of Candida Species in a Large Community Hospital

Abstract

INTRODUCTION: The T2Candida Panel is a newly FDA approved diagnostic product conducted from whole blood that enables species-specific detection of fungal pathogens in 3 to 5 h without the need for blood cultures. Use of this panel may enable clinicians to quickly initiate appropriate antifungal therapy, thus potentially reducing adverse outcomes and patient mortality. The T2Candida panel detects the following species: C. albicans, C. tropicalis, C. parapsilosis, C. krusei, and C. glabrata. The purpose of this study is to implement and evaluate the utilization of T2Candida Panel in a community hospital. RESEARCH QUESTION OR HYPOTHESIS: Implementation of the T2Candida Panel will positively impact patient care and reduce the use of antifungal agents at our institution. STUDY DESIGN: Prospective, observational analysis METHODS: This prospective, observational analysis included 136 inpatients at Huntsville Hospital who met our specified criteria. The T2Candida Panel was restricted to Infectious Disease (ID) and Oncology physicians' use. Endpoints included drug use, patient characteristics, risk factors, T2 results, corresponding blood cultures, time to de-escalation, and duration of therapy (DOT). RESULTS: Of the 160 T2 tests evaluated, 8.8% were positive. Approximately 36% of the positive T2 patients had a positive corresponding blood culture. The average duration of therapy (DOT) of micafungin for negative T2 patients was 4 days. The average time to de-escalation of therapy for negative T2 patients was 42.6 h. Patients displayed multiple risk factors, most of which overlapped, including 27.2% malnutrition, 32.4% renal failure, 27.2% intra-abdominal infection/surgery, 40.4% immunocompromised, 51.4% central line. Approximately 69% of the patients were in the ICU. CONCLUSION: The T2Candida panel has demonstrated greater sensitivity to Candida infections at our facility thus far and has provided a reduction in DOT of micafungin use. Despite the rapid nature of the test, time to de-escalation of therapy remained high at 2 days, demonstrating variations in level of physician confidence with T2 results.