84 - T2Candida Panel Use Evaluation: a Quality Improvement Project

Background: Invasive candidiasis is a life-threatening infection with 40% mortality despite antifungal therapy[1]. T2Candida uses T2MR technology to detect the 5 most common Candida species direct from whole blood within 3 to 5 hours, guiding rapid appropriate antifungal use. In our institution the test required ordering approval and questions assessing the risk of candidemia were built into the electronic medical record. The aim of this study was to assess test utilization and the impact of results on antifungal use.
 
[1] Clancy et al.; Finding the "Missing 50%" of Invasive Candidiasis: How Nonculture Diagnostics Will Improve Understanding of Disease Spectrum and Transform Patient Care; Clin Infect Dis. 2013 May;56(9):1284-92.

Methods: A retrospective chart review of results from our T2Candida Panels from March 2019 to March 2020 was conducted. We compared demographics, co-morbidities, days of antifungal use, length of stay (LOS) and mortality in patients with positive and negative assays.

Results: 271 assays were performed, 27 were positive and were compared to 81 negatives. Baseline demographics and co-morbidities were similar in both groups. All patients tested had >1 risk factor for candidemia.
78% were positive for C. albicans/C. tropicalis and 11% positive for C. glabrata/C. krusei and C. parapsilosis respectively. Blood cultures were positive in 8 individuals, of which 5 had a positive assay; among the other 3, one grew C. auris. All species in the T2Candida matched the blood cultures when available.
β-D-glucan was positive in 82% of patients with positive T2 results vs 46% in the T2 negative group  (p = 0.016).
Antifungal administration within the time of assay collection was 54% in the negative group vs 74% in the positive group (p = 0.030). Mean duration of antifungal use were significantly lower in the negative group than the positive group (5.98 vs 17.55 days, p = 0.04).Demographics and Comorbidities
Outcomes
Cultures


Conclusion: T2Candida was an effective diagnostic and antimicrobial stewardship tool, leading to testing in high risk patients and reducing unnecessary antifungal use.  Additional education is required for improved ordering of concurrent blood cultures. Negative results should be interpreted with caution in suspected invasive candidiasis with consideration for species not included in the panel.