616. Impact of Peptide Nucleic Acid Fluorescence in Situ Hybridization (PNA FISH) and Fluconazole Susceptibility Testing (FLU-ST) On the Time to Appropriate (AAT) and Optimal (OAT) Antifungal Therapy (Tx) for Candida Blood Stream Infections (BSIs)
Session: Abstracts: Mycology
Friday, October 22, 2010
Background: Candida BSIs are an important cause of mortality & morbidity; delays in initiation of AAT result in higher mortality. Since ~20% of Candida BSIs at UMHS are C. glabrata, of which only 33% are fully FLU-susceptible, performing rapid but expensive but ID & FLU-ST of Candida with PNA FISH & FLU-ST should help guide the use of appropriate (AAT) yet optimal (cost effective; OAT) AF Tx. At UMHS, FLU-ST of Candida BSIs was introduced in June 2008 and PNA FISH, a rapid (2.5 h) in vitro test to ID C. albicans & C. glabrata, in Oct 2008. The goal of this study was to determine if use of FLU-ST, or PNA FISH + FLU-ST, decreases time to AAT & OAT in Candida BSIs.

Methods: We evaluated initial adult & pediatric Candida + BCs (N=123) obtained during 3 study periods: PI= Jan -June 2008: prior to use of FLU-ST or PNA FISH [Control period]; P2= June - Dec 2008: use of FLU-ST without PNA FISH; P3= Dec 2008 - June 2009: use of FLU-ST PLUS PNA FISH. AAT was defined as the use of an AF with activity against the isolated Candida; OAT as the most cost-effective AAT (Tx consistent with IDSA candidemia guidelines). FLU-ST for isolates obtained in P1 were obtained clinically as “sendouts” or retrospectively from stored isolates.

Results: There were no significant differences in the time required for workup of Candida isolates (time to + BC alert to MDs, or speciation) during the 3 study periods. Time to OAT for C. glabrata was significantly delayed (P=0.01) when FLU-ST alone (without PNA FISH) was used, and FLU-ST required significantly longer when performed as a sendout during P1. 

 

P1 (N=41)

no FLU-ST or PNA FISH

P2 (N=35)

+ FLU-ST

P3 (N=47)

FLU-ST + PNA FISH

 

Timea (days) to: 

AAT (all species)

2.5 ± 2.7

              2.5 ± 3.1

2.1 ± 1.6

OAT (all species)

2.7 ± 2.9

              3.5 ± 3.7

2.4 ± 2.0

AAT (C. glabrata)

2.4 ± 2.8

              4.6 ± 4.2

2.9 ± 2.2

OAT (C. glabrata)

2.4 ± 2.8

              5.0 ± 4.5**

3.8 ± 3.0

+ BC alert to MD

2.4 ± 1.6

              2.5 ± 1.3

2.3 ± 1.3

PNA FISH results

Not done

              Not done

3.3 ± 1.8

Candida speciation

4.6 ± 1.8

              4.7 ± 1.8

5.5 ± 2.7

FLU-ST resultsb

   17.6 ± 15.1**

              6.8 ± 4.3

5.4 ± 2.7

atime zero is defined as the date/time the +BC was obtained. bDuring period 1, FLU-ST was not performed (as sendouts) for all patients

** P<0.05

Conclusion: Despite increased ­­time to FLU-ST , the addition of FLU-ST alone or + PNA FISH testing did NOT significantly decrease AAT or OAT for Candida BSIs.


Subject Category: M. Mycology including clinical and basic studies of fungal infections

Speakers:
Peggy L. Carver, PharmD, FCCP , University of Michigan College of Pharmacy, Ann Arbor, MI
Melissa A. Carroll, PharmD , University of Michigan Health System, Ann Arbor, MI
Carol Young, MT(ASCP) , University of Michigan Health System, Ann Arbor, MI
Peggy Mahlmeister, MLT(ASCP) , University of Michigan Health System, Ann Arbor, MI

Disclosures:

P. L. Carver, None

M. A. Carroll, None

C. Young, None

P. Mahlmeister, None

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