Abstract
Invasive candidiasis is a common healthcare-associated infection with a high mortality rate that can exceed 60% in cases of septic shock. Blood culture performance is far from ideal, due to the long time to positivity and suppression by antifungal agents. The T2 Magnetic Resonance (T2MR) assay is an FDA-approved qualitative molecular diagnostic method that can detect and speciate the 5 most common Candida spp.; namely, Candida albicans, Candida glabrata, Candida parapsilosis, Candida tropicalis, and Candida krusei, in approximately 5 h. In a multicenter clinical trial that included both a prospective and a contrived arm to represent the full range of clinically relevant concentrations of Candida spp., T2MR demonstrated a sensitivity and specificity of 91.1% and 98.1%, respectively. The utility of T2MR in candidemia depends on the prevalence of disease in each clinical setting. In intensive care units and other high-prevalence settings, the incorporation of T2MR in diagnostic algorithms is very appealing. T2MR is expected to allow timely initiation of antifungal therapy and help with anti-fungal stewardship. In low-prevalence settings, the positive predictive value of T2MR might not be enough to justify initiation of antifungal treatment in itself. The performance of T2MR has not been studied in cases of deep-seated candidiasis. Despite some promising evidence in published clinical trials, further studies are needed to determine the performance of T2MR in invasive candidiasis without candidemia. Overall, experience with T2MR in everyday clinical practice is evolving but, in the right setting, this technology is expected to provide “actionable information” for the management of patients evaluated for candidemia.
Highlights
Invasive candidiasis is estimated to represent about 6% of all hospital-acquired infections, with approximately 46,000 cases diagnosed each year in the U.S [1], and 250,000 cases worldwide, contributing to more than 50,000 deaths [2,3]
Despite some promising evidence in published clinical trials, further studies are needed to determine the performance of T2 Magnetic Resonance (T2MR) in invasive candidiasis without candidemia
Culture of blood and other tissue samples have historically been considered the gold standard for diagnosis of invasive candidiasis and remains the only method that allows for sensitivity testing of the isolated Candida spp., making culture an essential component of every diagnostic algorithm
Summary
Invasive candidiasis is estimated to represent about 6% of all hospital-acquired infections, with approximately 46,000 cases diagnosed each year in the U.S [1], and 250,000 cases worldwide, contributing to more than 50,000 deaths [2,3]. Primary candidemia can result in secondary deep-seated candidiasis in up to 50% of cases due to hematogenous seeding [5,6]. Direct seeding of tissues with Candida cells (e.g., in patients with recent abdominal surgery) may result in deep-seated candidiasis, which itself can result in secondary candidemia in approximately 20% of cases [7]. As invasive candidiasis includes a number of clinical conditions in a variety of hosts, the mortality associated with this infection varies significantly. In a meta-analysis of randomized clinical trials that included patients with all forms of invasive candidiasis, Andes et al calculated that the 30-day mortality in invasive candidiasis to be 31.4%, with a range among individual studies of 20–40%. Based on the significance of timely initiation of antifungal therapy, the development of minimally invasive, highly sensitive and specific diagnostic tests with a quick turn-around time and reasonable cost have the potential to significantly improve outcomes
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