Abstract
ABSTRACTThe performance of blood culture for monitoring candidemia clearance is hampered by its low sensitivity, especially during antifungal therapy. The T2 magnetic resonance (T2MR) assay combines magnetic resonance with nanotechnology to identify whole Candida species cells. A multicenter clinical trial studied the performance of T2MR in monitoring candidemia clearance compared to blood culture. Adults with a blood culture positive for yeast were enrolled and had blood cultures and T2MR testing performed on prespecified days. Thirty-one patients completed the trial. Thirteen of the 31 patients (41.9%) had at least one positive surveillance T2MR and/or blood culture result. All positive blood cultures (7/7 [100%]) had an accompanying positive T2MR result with concordance in the identified Candida sp., while only 7/23 (30.4%) T2MR results had an accompanying positive blood culture. There was one case of discordance in species identification between T2MR and the preenrollment blood culture with evidence to support deep-seated infection by the Candida spp. detected by the T2MR assay. Based on the log rank test, there was a statistically significant improvement in posttreatment surveillance using the T2MR assay compared to blood culture (P = 0.004). Limitations of the study include the small sample size and lack of outcome data. In conclusion, the T2MR assay significantly outperformed blood cultures for monitoring the clearance of candidemia in patients receiving antifungal therapy and may be useful in determining adequate source control, timing for deescalation, and optimal duration of treatment. However, further studies are needed to determine the viability of Candida species cells detected by the T2MR assay and correlate the results with patient outcomes. (This study is registered at ClinicalTrials.gov under registration number NCT02163889.)
Highlights
The performance of blood culture for monitoring candidemia clearance is hampered by its low sensitivity, especially during antifungal therapy
The low sensitivity, suppression by antifungal therapy, and prolonged time to result (3 to 5 days) deem blood cultures a suboptimal tool to guide the treatment of candidemia
NCT02163889), was to investigate the performance of the T2 magnetic resonance (T2MR) assay as a monitoring tool for posttherapy clearance of candidemia compared to blood cultures
Summary
The performance of blood culture for monitoring candidemia clearance is hampered by its low sensitivity, especially during antifungal therapy. The T2MR assay significantly outperformed blood cultures for monitoring the clearance of candidemia in patients receiving antifungal therapy and may be useful in determining adequate source control, timing for deescalation, and optimal duration of treatment. As part of optimal antifungal therapy, the most recent Infectious Diseases Society of America (IDSA) clinical practice guidelines support follow-up blood cultures every 24 to 48 h in order to monitor clearance of candidemia, determine the need for further interventions for source control, and guide deescalation and the total duration of therapy [6]. Early in vitro interference studies for exogenous substances have shown that the T2MR assay is not suppressed by the presence of antifungal agents [8, 15] The purpose of this multicenter prospective clinical trial, designated the Serial Therapeutic and Antifungal Monitoring Protocol (STAMP) trial NCT02163889), was to investigate the performance of the T2MR assay as a monitoring tool for posttherapy clearance of candidemia compared to blood cultures
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