1569. T2 Magnetic Resonance Improves Timely Management of Candidemia
Session: Poster Abstract Session: Mycology: Diagnostic
Friday, October 28, 2016
Room: Poster Hall
Posters
  • T2MR Timely Candidemia Management 2016.pdf (314.3 kB)
  • Background: Prompt diagnosis of Candida-bloodstream infections is a barrier to early, active antifungal therapy which is vital for improved patient survival. We implemented T2 magnetic resonance (T2) testing in 11/2015. The purpose of this investigation was to compare time to early active antifungal therapy before and after implementation of T2.

    Methods: IRB approved pre/post-test quasi-experiment in a 4 hospital health-system from 4/2015 to 5/2016. Pre-T2: first episode of candidemia detected by blood culture or beta-glucan (BDG) ≥ 200 pg/mL. Post-T2: first episode of candidemia detected by blood culture, BDG or T2. Primary endpoint: time to active therapy, defined as the difference between the time of first specimen collection to time that the first active antifungal was administered. Secondary endpoints: time to identification and patient outcomes.

    Results: 142 patients included: 87 pre-T2, 55 post-T2. Baseline characteristics were similar between groups, except 63 (72.4%) and 47 (85.5%) of patients were treated in the ICU pre/post-T2, respectively, P= 0.07. ID consult management: Pre-T2 in 84 (97%) and Post-T2 in 53 (96%), P =0.953. Microbiology and antifungal therapy are presented in table 1. Length of stay (LOS), days after candidemia onset: Pre-T2- 13 (7-23) days, Post-T2- 9 (6-21) days, P=0.164. ICU LOS, days after candidemia onset: Pre-T2- 13 (6-21); Post-T2- 6 (4-13), P=0.009. In hospital, all cause mortality: Pre-T2- 29 (33%); Post-T2- 17 (39.5%), P=0.49. T2 subgroup: Initial echinocandin therapy in 21 (91.3%); median (IQR) time to identification in 7.1 (4.1,17) hours; median (IQR) time to active therapy 13.4 (2.2, 32.3) hours.

    Conclusion: T2 implementation was associated with improved time to identification, time to active therapy, and shorter ICU LOS among patients with candidemia.

    Table 1. Microbiology and Antifungal Therapy

    Variable

    Pre-T2

    Post-T2

    p-value

    Method of Diagnosis

    BDG

    Blood culture

    T2

    40 (46%)

    47 (54%)

    0

    5 (9%)

    27(49%)

    23 (42%)

    N/A

    Species Identified

                    albicans/tropicalis

                    glabrata/krusei

                    parapsilosis

                    other

    25 (29%)

    11 (13%)

    10 (12%)

    4 (5%)

    23 (43%)

    11 (20%)

    10 (19%)

    9 (17%)

    0.097

    Median (IQR) time to identification

    41.75 hours (30.1, 65.9)

    25.25 hours (6.3, 43)

    0.01

    Median (IQR) time to active therapy

    39.6 hours (12.9, 54.75)

    26. 6 hours (2.5, 47.1)

    0.01

    Echinocandin initial therapy

    63 (72%)

    47 (85.5%)

    0.23

    Nicole Wilson, PharmD1, Rachel M Kenney, PharmD1, Robert Tibbetts, Ph.D. D(ABMM), F(CCM)2, George Alangaden, MD, FIDSA3, Susan L Davis, PharmD4 and Linoj Samuel, PhD., D(ABMM)5, (1)Pharmacy, Henry Ford Hospital, Detroit, MI, (2)Department of Pathology and Laboratory Medicine, Henry Ford Hospital, Detroit, MI, (3)Infectious Diseases, Henry Ford Hospital, Detroit, MI, (4)Wayne State University College of Pharmacy, Detroit, MI, (5)Microbiology, Henry Ford Hospital, Detroit, MI

    Disclosures:

    N. Wilson, None

    R. M. Kenney, None

    R. Tibbetts, None

    G. Alangaden, astellas: Scientific Advisor , Consulting fee

    S. L. Davis, None

    L. Samuel, None

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