T2Candida MR as a predictor of outcome in patients with suspected invasive candidiasis starting empirical antifungal treatment: a prospective pilot study

Muñóz, Patricia; Machado, Marina; Gioia, Francesca; Martínez-Jiménez, M. Carmen; Gómez, Elia; Origüen, Julia; Orellana, María Ángeles; López‐Medrano, Francisco; Fernández‐Ruiz, Mario; Merino, Paloma; González-Romo, Fernando; Frías, Isabel; Pérez‐Granda, María Jesús; Aguado, José María; Fortün, Jesús; Bouza, Emilio

doi:10.1093/jac/dky047

Cited by 49 publications

(32 citation statements)

References 30 publications

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“…Of interest, in the present report, the overall 30-day mortality rate in patients with septic shock attributable to candidemia was 34.3%, which is significantly lower than that observed in two previous studies performed in Europe and St. Louis, where mortality rate remained around 50-60% [4,5]. The difference in septic shock definitions [9], improvements in fungal diagnosis [33,34], and the widespread implementation of sepsis bundle in recent years [38][39][40] may explain the lower incidence of mortality observed in this study.…”

Section: Discussioncontrasting

confidence: 46%

“…The fact that patients with other source of the infection (i.e., CVC or urinary tract) received a similar rate of adequate source control of candidemia (43.4% vs 40.5%, p = 0.86) and even a lower rate of adequate antifungal treatment (38.1% vs 61.5%, p = 0.008) is further consistent with this intriguing explanation. Although we do not have clear answer regarding to the best approach for reducing the incidence of septic shock in candidemic patients, we believe that new diagnostic strategies investigating the role of serological biomarkers such as β-D-glucan or T2MR [32][33][34][35] should be applied in order to early identify patients at risk of intra-abdominal candidiasis. Future studies addressing risk factors for developing intra-abdominal candidiasis are also needed to better clarify the best empiric or pre-emptive therapeutic approach.…”

Section: Discussionmentioning

confidence: 97%

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Factors associated with the development of septic shock in patients with candidemia: a post hoc analysis from two prospective cohorts

et al. 2020

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Background: Almost one third of the patients with candidemia develop septic shock. The understanding why some patients do and others do not develop septic shock is very limited. The objective of this study was to identify variables associated with septic shock development in a large population of patients with candidemia. Methods: A post hoc analysis was performed on two prospective, multicenter cohort of patients with candidemia from 12 hospitals in Spain and Italy. All episodes occurring from September 2016 to February 2018 were analyzed to assess variables associated with septic shock development defined according to The Third International Consensus Definition for Sepsis and Septic Shock (Sepsis-3). Results: Of 317 candidemic patients, 99 (31.2%) presented septic shock attributable to candidemia. Multivariate logistic regression analysis identifies the following factors associated with septic shock development: age > 50 years (OR 2.57, 95% CI 1.03-6.41, p = 0.04), abdominal source of the infection (OR 2.18, 95% CI 1.04-4.55, p = 0.04), and admission to a general ward at the time of candidemia onset (OR 0.21, 95% CI, 0.12-0.44, p = 0.001). Septic shock development was independently associated with a greater risk of 30-day mortality (OR 2.14, 95% CI 1.08-4.24, p = 0.02). Conclusions: Age and abdominal source of the infection are the most important factors significantly associated with the development of septic shock in patients with candidemia. Our findings suggest that host factors and source of the infection may be more important for development of septic shock than intrinsic virulence factors of organisms.

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Section: Discussioncontrasting

confidence: 46%

Section: Discussionmentioning

confidence: 97%

Factors associated with the development of septic shock in patients with candidemia: a post hoc analysis from two prospective cohorts

et al. 2020

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“…153 Of note, some authors have also suggested that a positive T2Candida test could be a potential marker of poor outcome in patients receiving empirical antifungal therapy for suspected IC. 154 In the future, it is likely that cumulative evidence from different real-life experiences will allow to precisely delineate the positioning of the T2Candida panel within diagnostic algorithms, and to maximize its cost-effectiveness (also considering the local prevalence or Candida species not included in the panel). [155][156][157]…”

Section: Rapid Tests Based On Polymerase Chain Reactionmentioning

confidence: 99%

“…Despite these results, the fact is that the empirical approach remains a common practice both inside and outside ICU 154 and its role in high-risk patients still remains to be determined. In our opinion, further studies aimed to specify criteria for early initiation of antifungal therapy in critically ill patients are needed.…”

Section: Empirical Approachmentioning

confidence: 99%

Diagnosis and Treatment of Candidemia in the Intensive Care Unit

Bassetti

Giacobbe

Vena

et al. 2019

Semin Respir Crit Care Med

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Candidemia is the fourth most frequent health care-associated bloodstream infection, and the most frequent severe fungal infection developing in critically ill patients in intensive care units (ICUs). Diagnosis of candidemia in ICU patients is a complex task made of both early and late assessments involving both conventional diagnostic methods and novel rapid tests. Management strategies to optimize treatment of candidemia can be challenging and include starting early adequate therapy, use of an adequate dose and duration of therapy, de-escalating treatment whenever possible, and early discontinuation of useless antifungals in those with no definitive diagnosis of fungal infection. Herein, we will discuss recent epidemiological data on candidemia in ICUs and current diagnostic techniques before concentrating on antifungal treatments.

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“…Although a mortality benefit was not observed, possibly because of a small sample size, previous studies associate mortality benefits with expedited time to effective therapy among candidemia patients (30,31). A recent study evaluated the diagnostic value of T2Candida, Candida albicans germ tube antibodies (CAGT), and β-D-glucan (BDG) in predicting poor outcomes (i.e., diagnosis of invasive candidiasis defined as candidemia and deep-seated candidiasis, and/or death within the first 7 days of initiating antifungal therapy) for patients on definitive antifungal therapy (32). Although difference between good vs poor outcome was not differentiated by CAGT or BDG, a positive T2Candida was more commonly present in poor outcomes [5 of 14 (35.7%) vs 0 of 35 (0%); P = 0.0001].…”

Section: Direct Specimen Testingmentioning

confidence: 99%

Interplay between Rapid Diagnostic Tests and Antimicrobial Stewardship Programs among Patients with Bloodstream and Other Severe Infections

Beganovic

McCreary

Mahoney

et al. 2019

The Journal of Applied Laboratory Medicine

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Background Antimicrobial stewardship programs (ASPs) aim to provide optimal antimicrobial therapy to patients quickly to improve the likelihood of overcoming infection while reducing the risk of adverse effects. Rapid diagnostic tests (RDTs) for infectious diseases have become an integral tool for ASPs to achieve these aims. Content This review explored the demonstrated clinical value of longer-standing technologies and implications of newer RDTs from an antimicrobial stewardship perspective. Based on available literature, the focus was on the use of RDTs in bloodstream infections (BSIs), particularly those that perform organism identification and genotypic resistance detection, phenotypic susceptibility testing, and direct specimen testing. Clinical implications of rapid testing among respiratory, central nervous system, and gastrointestinal infections are also reviewed. Summary Coupling RDTs with ASPs facilitates the appropriate and timely use of test results, translating into improved patient outcomes through optimization of antimicrobial use. These benefits are best demonstrated in the use of RDT in BSIs. Rapid phenotypic susceptibility testing offers the potential for early pharmacokinetic/pharmacodynamic optimization, and direct specimen testing on blood may allow ASPs to initiate appropriate therapy and/or tailor empiric therapy even sooner than other RDTs. RDTs for respiratory, central nervous system, and gastrointestinal illnesses have also shown significant promise, although more outcome studies are needed to evaluate their full impact.

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T2Candida MR as a predictor of outcome in patients with suspected invasive candidiasis starting empirical antifungal treatment: a prospective pilot study

Cited by 49 publications

References 30 publications

Factors associated with the development of septic shock in patients with candidemia: a post hoc analysis from two prospective cohorts

Factors associated with the development of septic shock in patients with candidemia: a post hoc analysis from two prospective cohorts

Diagnosis and Treatment of Candidemia in the Intensive Care Unit

Interplay between Rapid Diagnostic Tests and Antimicrobial Stewardship Programs among Patients with Bloodstream and Other Severe Infections

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