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Stewardship-Guided T2Candida Testing Shortens Time to Antifungal Treatment and Reduces Antifungal Usage Among Medical Intensive Care Unit Patients With Septic Shock

BACKGROUND: Diagnosis of invasive candidiasis (IC) is limited by insensitivity and slow turnaround of cultures. Our objectives were to define the performance of T2Candida, a nonculture test, under guidance of a diagnostic stewardship program, and evaluate impact on time to antifungal initiation and...

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Autores principales: O’Donnell, Matthew, Shields, Ryan K, Marini, Rachel V, Groetzinger, Lara M, Potoski, Brian A, Falcione, Bonnie A, Shah, Sunish, McCreary, Erin K, Clarke, Lloyd, Brant, Emily, McVerry, Bryan J, Liegey, Susan, Pasculle, A William, Clancy, Cornelius J, Nguyen, M Hong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10651185/
https://www.ncbi.nlm.nih.gov/pubmed/38023565
http://dx.doi.org/10.1093/ofid/ofad538
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author O’Donnell, Matthew
Shields, Ryan K
Marini, Rachel V
Groetzinger, Lara M
Potoski, Brian A
Falcione, Bonnie A
Shah, Sunish
McCreary, Erin K
Clarke, Lloyd
Brant, Emily
McVerry, Bryan J
Liegey, Susan
Pasculle, A William
Clancy, Cornelius J
Nguyen, M Hong
author_facet O’Donnell, Matthew
Shields, Ryan K
Marini, Rachel V
Groetzinger, Lara M
Potoski, Brian A
Falcione, Bonnie A
Shah, Sunish
McCreary, Erin K
Clarke, Lloyd
Brant, Emily
McVerry, Bryan J
Liegey, Susan
Pasculle, A William
Clancy, Cornelius J
Nguyen, M Hong
author_sort O’Donnell, Matthew
collection PubMed
description BACKGROUND: Diagnosis of invasive candidiasis (IC) is limited by insensitivity and slow turnaround of cultures. Our objectives were to define the performance of T2Candida, a nonculture test, under guidance of a diagnostic stewardship program, and evaluate impact on time to antifungal initiation and antifungal utilization. METHODS: This was a retrospective study of adult medical intensive care unit (MICU) patients with septic shock for whom T2Candida testing was performed from March 2017 to March 2020. Patients with positive T2Candida results during this period were compared to MICU patients who did not undergo T2Candida testing but had septic shock and blood cultures positive for Candida from January 2016 through March 2020. RESULTS: Overall, 155 T2Candida tests from 143 patients were included. Nine percent of T2Candida tests were positive compared to 4.5% of blood cultures. Sensitivity, specificity, positive predictive value, and negative predictive value of T2Candida for proven and probable IC were 78%, 95%, 50%, and 99%, respectively. Patients who tested positive for T2Candida (n = 14) were diagnosed earlier and initiated on antifungal therapy sooner than patients with IC (n = 14) diagnosed by blood culture alone (median, 5.6 vs 60 hours; P < .0001). Median antifungal days of therapy/1000 patient-days were 23.3/month preimplementation and 15/month postimplementation (P  = .007). Following a negative T2Candida result, empiric antifungals were either not administered in 58% or discontinued within 72 hours in 96% of patients. CONCLUSIONS: Diagnostic stewardship guided T2Candida testing resulted in reduced time to IC diagnosis, faster initiation of antifungal therapy, and lower antifungal usage among MICU patients with septic shock.
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spelling pubmed-106511852023-11-08 Stewardship-Guided T2Candida Testing Shortens Time to Antifungal Treatment and Reduces Antifungal Usage Among Medical Intensive Care Unit Patients With Septic Shock O’Donnell, Matthew Shields, Ryan K Marini, Rachel V Groetzinger, Lara M Potoski, Brian A Falcione, Bonnie A Shah, Sunish McCreary, Erin K Clarke, Lloyd Brant, Emily McVerry, Bryan J Liegey, Susan Pasculle, A William Clancy, Cornelius J Nguyen, M Hong Open Forum Infect Dis Major Article BACKGROUND: Diagnosis of invasive candidiasis (IC) is limited by insensitivity and slow turnaround of cultures. Our objectives were to define the performance of T2Candida, a nonculture test, under guidance of a diagnostic stewardship program, and evaluate impact on time to antifungal initiation and antifungal utilization. METHODS: This was a retrospective study of adult medical intensive care unit (MICU) patients with septic shock for whom T2Candida testing was performed from March 2017 to March 2020. Patients with positive T2Candida results during this period were compared to MICU patients who did not undergo T2Candida testing but had septic shock and blood cultures positive for Candida from January 2016 through March 2020. RESULTS: Overall, 155 T2Candida tests from 143 patients were included. Nine percent of T2Candida tests were positive compared to 4.5% of blood cultures. Sensitivity, specificity, positive predictive value, and negative predictive value of T2Candida for proven and probable IC were 78%, 95%, 50%, and 99%, respectively. Patients who tested positive for T2Candida (n = 14) were diagnosed earlier and initiated on antifungal therapy sooner than patients with IC (n = 14) diagnosed by blood culture alone (median, 5.6 vs 60 hours; P < .0001). Median antifungal days of therapy/1000 patient-days were 23.3/month preimplementation and 15/month postimplementation (P  = .007). Following a negative T2Candida result, empiric antifungals were either not administered in 58% or discontinued within 72 hours in 96% of patients. CONCLUSIONS: Diagnostic stewardship guided T2Candida testing resulted in reduced time to IC diagnosis, faster initiation of antifungal therapy, and lower antifungal usage among MICU patients with septic shock. Oxford University Press 2023-11-08 /pmc/articles/PMC10651185/ /pubmed/38023565 http://dx.doi.org/10.1093/ofid/ofad538 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Major Article
O’Donnell, Matthew
Shields, Ryan K
Marini, Rachel V
Groetzinger, Lara M
Potoski, Brian A
Falcione, Bonnie A
Shah, Sunish
McCreary, Erin K
Clarke, Lloyd
Brant, Emily
McVerry, Bryan J
Liegey, Susan
Pasculle, A William
Clancy, Cornelius J
Nguyen, M Hong
Stewardship-Guided T2Candida Testing Shortens Time to Antifungal Treatment and Reduces Antifungal Usage Among Medical Intensive Care Unit Patients With Septic Shock
title Stewardship-Guided T2Candida Testing Shortens Time to Antifungal Treatment and Reduces Antifungal Usage Among Medical Intensive Care Unit Patients With Septic Shock
title_full Stewardship-Guided T2Candida Testing Shortens Time to Antifungal Treatment and Reduces Antifungal Usage Among Medical Intensive Care Unit Patients With Septic Shock
title_fullStr Stewardship-Guided T2Candida Testing Shortens Time to Antifungal Treatment and Reduces Antifungal Usage Among Medical Intensive Care Unit Patients With Septic Shock
title_full_unstemmed Stewardship-Guided T2Candida Testing Shortens Time to Antifungal Treatment and Reduces Antifungal Usage Among Medical Intensive Care Unit Patients With Septic Shock
title_short Stewardship-Guided T2Candida Testing Shortens Time to Antifungal Treatment and Reduces Antifungal Usage Among Medical Intensive Care Unit Patients With Septic Shock
title_sort stewardship-guided t2candida testing shortens time to antifungal treatment and reduces antifungal usage among medical intensive care unit patients with septic shock
topic Major Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10651185/
https://www.ncbi.nlm.nih.gov/pubmed/38023565
http://dx.doi.org/10.1093/ofid/ofad538
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