T2Candida Assay in the Diagnosis of Intraabdominal Candidiasis: A Prospective Multicenter Study.

Anders Krifors,Markus Castegren,Ernesto Sparrelid,Johan Petersson,Helena Hammarström,Ola Blennow,Volkan Özenci,Jan Sjölin,Måns Ullberg

doi:10.3390/jof8010086

Abstract

The T2Candida magnetic resonance assay is a direct-from-blood pathogen detection assay that delivers a result within 3–5 h, targeting the most clinically relevant Candida species. Between February 2019 and March 2021, the study included consecutive patients aged >18 years admitted to an intensive care unit or surgical high-dependency unit due to gastrointestinal surgery or necrotizing pancreatitis and from whom diagnostic blood cultures were obtained. Blood samples were tested in parallel with T2Candida and 1,3-β-D-glucan. Of 134 evaluable patients, 13 (10%) were classified as having proven intraabdominal candidiasis (IAC) according to the EORTC/MSG criteria. Two of the thirteen patients (15%) had concurrent candidemia. The sensitivity, specificity, positive predictive value, and negative predictive value, respectively, were 46%, 97%, 61%, and 94% for T2Candida and 85%, 83%, 36%, and 98% for 1,3-β-D-glucan. All positive T2Candida results were consistent with the culture results at the species level, except for one case of dual infection. The performance of T2Candida was comparable with that of 1,3-β-D-glucan for candidemic IAC but had a lower sensitivity for non-candidemic IAC (36% vs. 82%). In conclusion, T2Candida may be a valuable complement to 1,3-β-D-glucan in the clinical management of high-risk surgical patients because of its rapid results and ease of use.

Highlights

Invasive candidiasis (IC) is a severe infection associated with an attributable mortality of up to 40% [1,2]
Of the 143 consecutive patients intended for inclusion, 9 patients were excluded due to missing one or more of the diagnostic tests
We included 134 consecutive high-risk surgical patients treated in intensive care unit (ICU)/high dependency unit (HDU) with suspicion of a new infection

Summary

Introduction

Invasive candidiasis (IC) is a severe infection associated with an attributable mortality of up to 40% [1,2]. The incidence of candidemia is increasing among patients in the intensive care unit (ICU), accounting for approximately 5–15% of all bloodstream infections [3]. Even though effective antifungal therapy is available, a successful outcome depends on a timely diagnosis, prompt initiation of an appropriate treatment, and source control [4]. In the ICU, IC is generally observed as candidemia or intraabdominal candidiasis (IAC) related to intraabdominal surgery or necrotizing pancreatitis [5,6,7]. The detection of 1,3β-D-glucan (BDG), a fungal cell wall component, may support IC diagnosis but must be interpreted in a proper clinical context since BDG is not Candida-specific and false-positive results due to concomitant therapies or infections have been reported [10,11]

Objectives

Methods

Results

Conclusion