1030. Impact of Peptide Nucleic Acid Fluorescence In Situ Hybridization-Based (PNA FISHTM) Identification of Candida Species on Patient Outcomes
Session: Poster Abstract Session: Diagnosis of Bloodstream / Cardiovascular Infections
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • P-Heil-PNA FISH Poster IDSA Final.pdf (540.7 kB)
  • Background: Peptide nucleic acid-fluorescence in situ hybridization (Yeast Traffic LightTM PNA FISHTM) is a rapid test used by University of North Carolina (UNC) McLendon Labs to identify and differentiate Candida species directly from positive blood cultures.  PNA FISHTM utilizes fluorescence-labeled probes targeting the specific RNA sequences of Candida species in ~90 minutes.  The hypothesis of our study was that the PNA FISHTM test and its corresponding pharmacy protocol would decrease time to Candida species identification and therefore decrease time to targeted antifungal therapy. 

    Methods: This was a comparative study assessing patients with candidemia prior to and post-implementation of the PNA FISH™ test.  The primary endpoint was the time to targeted therapy which was defined as the time, in days, from a blood culture positive for yeast to dispensation of targeted drug therapy.  Secondary endpoints included the time to Candida species identification and clinical outcomes including time to culture clearance, length of hospital stay, and hospital mortality.  The results for normally distributed data are presented as mean (± standard deviation) and were analyzed using 2-tailed student’s t-test for unequal variance.

    Results: A total of 80 patients were evaluated; 19 in the case group (post-PNA FISH™ test) and 61 in the control group (pre-test period).  Time to targeted therapy was decreased from a mean of 2.3 (± 3.5) days in the control group to 0.63  (± 1.3) days in the case group (p=0.029).  The mean time to Candida species identification in the case group with PNA FISH™ was 0.24 (± 0.19) days, compared to 4.6 (± 2.3) days by traditional methods in the control group (p<0.001). Mean time to culture clearance was 4.5 (± 2.8) days in the case group compared to 5.7 (± 3.5) days in the control group (p=0.17).  Median length of stay in the case group was 11 days (range 5-153) compared to 25 days (range 5-277) in the control group (p=0.46).  In-hospital mortality was 21% in the case group compared to 31% in the control group (p=0.56, 2-tailed Fisher’s exact test).

    Conclusion: The Yeast Traffic Light™ PNA FISH™ test is an effective tool to decrease time to Candida species identification in yeast positive blood cultures, and to decrease the time to dispensation of targeted therapy.


    Subject Category: D. Diagnostic microbiology

    Emily Heil, PharmD, BCPS1, Lindsay Daniels, PharmD, BCPS1, David Weber, MD, MPH, FIDSA2 and Melissa Miller, PhD2, (1)Pharmacy, University of North Carolina Hospitals, Chapel Hill, NC, (2)University of North Carolina, Chapel Hill, NC

    Disclosures:

    E. Heil, None

    L. Daniels, None

    D. Weber, Cubist: Collaborator, Consultant, Research Contractor and Speaker's Bureau, Consulting fee, Research grant and Speaker honorarium
    Merck: Scientific Advisor and Speaker's Bureau, Consulting fee and Speaker honorarium
    GSK: Scientific Advisor, Consulting fee and Speaker honorarium
    Pfizer: Scientific Advisor and Speaker's Bureau, Consulting fee and Speaker honorarium
    Ortho: Scientific Advisor and Speaker's Bureau, Consulting fee and Speaker honorarium
    Sanofi: Scientific Advisor and Speaker's Bureau, Consulting fee and Speaker honorarium

    M. Miller, None

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