Program Schedule

1447
Intra-abdominal Candidiasis: Description of an Under-appreciated Disease and a Case Report of Rapid Diagnosis by Whole Blood T2Candida Assay

Session: Poster Abstract Session: Fungal Infections
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Intra-abdominal candidiasis (IAC) is less well-recognized than candidemia.  Diagnosis is made by deep tissue culture.  Non-invasive, non-culture assays would improve diagnoses.

Methods: We performed a 2-year, observational study of patients (pts) with proven IAC.  T2Candida assay was performed as part of a clinical trial.

Results: IAC was the most common invasive candidiasis (IC) at our center (52% vs 35% for candidemia).  IAC (n=122) was primary (spontaneous or dialysis-associated) in 15% of pts.  Secondary IAC resulted from surgery (45%), perforation (30%), transmural colitis (16%), and other causes (9%). Pts with post-surgical IAC had procedures of colon (51%), small bowel (24%), liver/biliary (15%) and esophagus (10%). Perforations involved small bowel (63%), G-tube (25%) and colon (11%). Antifungal breakthrough infection occurred in 11%. 50% of pts had abscesses (IAA), 42% peritonitis and 8% peritonitis+IAA. Pathogens were C. albicans (58%), C. glabrata (23%), C. parapsilosis (8%) and C. tropicalis (4%); 65% of pts were co-infected with bacteria. Mortality was 23%, and higher for pts with perforation (50% vs 11%; p=0.04). 27% of survivors required prolonged antifungal therapy and/or repeated surgeries. 38% of pts did not initially receive an antifungal agent; 50% of these pts developed persistent IAC, and 20% died. Overall, only 12% of pts had (+) blood culture.  Recently, a liver transplant pt with IAA receiving voriconazole prophylaxis was diagnosed with C. albicans infection by T2Candida assay, a non-culture, whole blood detection system with limit of detection=1 CFU/mL.  The diagnosis was confirmed 7 days later by culture of surgically-drained IAA fluid.  Multiple blood cultures were negative.   

Conclusion: IAC was the most common IC at our center, and was associated with high mortality, need for repeated surgeries, and antifungal breakthrough infections. Clinicians could not reliably identify pts who were cured with surgical drainage alone, indicating that all pts require antifungal therapy. Blood cultures have extremely poor sensitivity.  The whole blood T2Candida assay may result in more rapid diagnoses and initiation of antifungal therapy against IAC and other types of IC (turn-around ~4 hrs), with low false-positivity.

Cornelius Clancy, MD, Infectious Disease, University of Pittsburgh Medical Center, Pittsburgh, PA and Minh-Hong Nguyen, MD, Infectious Disease, University of Pittsburgh, Pittsburgh, PA

Disclosures:

C. Clancy, T2 Biosystems: Investigator, Site investigator in clinical trial
Pfizer: Grant Investigator, Research grant
Merck: Grant Investigator, Research grant
Astellas: Grant Investigator, Research grant

M. H. Nguyen, Pfizer: Grant Investigator, Research grant
Merck: Grant Investigator, Research grant
Astellas: Grant Investigator, Research grant

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