Utilization of T2Candida Panel for the rapid detection of Candida species in a large community hospital

Background: The T2Candida Panel is a newly FDA approved diagnostics conducted from whole blood that detects 5 Candida species: C. albicans, C. tropicalis, C. parapsilosis, C. krusei, and C. glabrata in 3 to 5 hours without the need for blood cultures. The purpose of this study is to implement and evaluate the utilization of T2Candida Panel in a large community hospital.

Methods: Prospective, observational analysis included 160 patients who met our specified criteria. The T2Candida Panel was restricted to Infectious Disease (ID) and Oncology physicians’ use for specific patient populations, including with: febrile neutropenia; ICU stay for >72 hours, central venous catheter, recent antibiotics, acute pancreatitis, recent major surgery, TPN, renal failure/hepatic failure, corticosteroids and unexplained fever.

Results: Patients mean age 61 years, 52% were male. Most common comorbidities included DM, CKD, and COPD. Candidemia risk factors included: 27.2% malnutrition/TPN, 32.4% renal failure, 27.2% intra-abdominal infection/surgery, 40.4% immunocompromised (cancer, chemotherapy, chronic steroids, febrile neutropenia), 51.4% CVC/PICC line. 69% of the patients were in the ICU. Of the 160 T2 tests evaluated, 8.8% were positive. The resulting species were as follows: 6 C. albicans/tropicalis, 7 C. parapsilosis, and 1 resulted with both C. albicans/tropicalis and C. parapsilosis. Only 36% of the positive T2 patients had a positive corresponding blood culture with 100% concordance. There was no positive blood culture for candida species and negative T2 test. The mean duration of therapy (DOT) of micafungin and time to de-escalation for negative T2 patients was 4 days and 42.6 hours respectively, equating to about $280 per patient. When results were divided according to the 3 ID physician groups, the mean DOT for negative T2 patients were as follows: 1.1, 5.6, and 3.4 days. The time to de-escalation/discontinuation of therapy for the 3 physician groups were 15, 52.4, and 54 hours.

Conclusion: The T2Candida panel has demonstrated greater sensitivity to detect Candidemia at our facility and has provided a much faster time of antifungal treatment modification, but inconsistent utilization of the test results between different ID physicians were observed.