1774. Detecting Infections Rapidly and Easily for Candidemia Trial (DIRECT1): A Prospective, Multicenter Study of the T2Candida Panel
Session: Oral Abstract Session: The Fungus Among-us - Clinical Advances
Saturday, October 7, 2017: 8:30 AM
Room: 01AB
Background: Blood cultures (BC) are the diagnostic gold standard for candidemia, but sensitivity is <50%. T2Candida (T2) is a novel, FDA-approved nanodiagnostic panel, which utilizes T2 magnetic resonance and a dedicated instrument to detect Candida within whole blood samples.

Methods: Candidemic adults were identified at 14 centers by diagnostic BC (dBC). Follow-up blood samples were collected from all patients (pts) for testing by T2 and companion BC (cBC). T2 was run in batch at a central lab; results are reported qualitatively for 3 groups of spp (Candida albicans/C. tropicalis (CA/CT), C. glabrata/C. krusei (CG/CK), or C. parapsilosis (CP)). T2 and cBC were defined as positive (+) if they detected a sp. identified in dBC.

Results: 152 pts were enrolled (median age: 54 yrs (18-93); 54% (82) men). Candidemia risk factors included indwelling catheters (82%, 125), abdominal surgery (24%, 36), transplant (22%, 33), cancer (22%, 33), hemodialysis (17%, 26), neutropenia (10%, 15). Mean times to Candida detection/spp. identification by dBC were 47/133 hrs (2/5.5 d). dBC revealed CA (30%, 46), CG (29%, 45), CP (28%, 43), CT (11%, 17) and CK (3%, 4). Mean time to collection of T2/cBC was 62 hrs (2.6 d). 74% (112) of pts received antifungal (AF) therapy prior to T2/cBC (mean: 55 hrs (2.3 d)). Overall, T2 results were more likely than cBC to be + (p<0.0001; Table), a result driven by performance in AF-treated pts (p<0.0001). T2 was more likely to be + among pts originally infected with CA (61% (28) vs. 20% (9); p=0.001); there were trends toward higher positivity in pts infected with CT (59% (17) vs. 23% (4; p=0.08) and CP (42% (18) vs. 28% (12); p=0.26). T2 was + in 89% (32/36) of pts with + cBC.

Conclusion: T2 was sensitive for diagnosing candidemia at the time of + cBC, and it was significantly more like to be + than cBC among AF-treated pts. T2 is an important advance in the diagnosis of candidemia, which is likely to be particularly useful in pts receiving prophylactic, pre-emptive or empiric AF therapy.

Pt group (n)

Test results, n (%)

T2+

T2-

cBC+

cBC-

T2+/cBC+

T2+/cBC-

T2-/cBC+

T2-/cBC-

All

(152)

69

(45%)

83

(55%)

36

(24%)

116

(76%)

32

(21%)

37

(24%)

4

(3%)

79

(52%)

Prior AF

(112)

55

(49%)

57

(51%)

23

(20%)

89

(80%)

20

(18%)

35

(31%)

3

(3%)

54

(48%)

No AF

(40)

14

(35%)

26

(65%)

13

(32%)

27

(68%)

12

(30%)

2

(5%)

1

(2%)

25

(62%)

Cornelius J. Clancy, M.D., Infectious Diseases, University of Pittsburgh, Pittsburgh, PA, Peter Pappas, MD, Division of Infectious Disease, University of Alabama at Birmingham, Birmingham, AL, Jose Vazquez, MD, FACP, FIDSA, Georgia Regents University, Augusta, GA, Marc A. Judson, MD, Albany Medical College, Albany, NY, Ellis Tobin, MD, FIDSA, Albany Medical Center, Albany, NY, Dimitrios P. Kontoyiannis, MD, ScD, PhD (Hon), FACP, FIDSA, FECMM, FAAM, Department of Infectious Diseases Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, George R. Thompson, MD, Medical Microbiology and Immunology, University of California, Davis, Davis, CA, Annette Reboli, MD, UMDNJ/Robert Wood Johnson Medical School, Camden, NJ, Kevin W. Garey, PharmD, M.S., Pptr, University of Houston College of Pharmacy, Houston, TX, Richard N. Greenberg, MD, FIDSA, Department of Medicine, University of Kentucky School of Medicine, Lexington, KY, Luis Ostrosky-Zeichner, MD, FIDSA, FSHEA, Division of Infectious Diseases, Department of Internal Medicine, McGovern Medical School, Houston, TX, Alan Wu, MD, UCSF, San Francisco, CA, G. Marshall Lyon III, MD, Emory University School of Medicine, Atlanta, GA, Senu Apewokin, MD, University of Cincinnati, Cincinnati, OH, M. Hong Nguyen, MD, Infectious Disease, University of Pittsburgh, Pittsburgh, PA and Angela Caliendo, MD, PhD, FIDSA, Medicine, Alpert Medical School of Brown University, Providence, RI

Disclosures:

C. J. Clancy, None

P. Pappas, None

J. Vazquez, None

M. A. Judson, None

E. Tobin, None

D. P. Kontoyiannis, Pfizer: Research Contractor , Research support and Speaker honorarium
Astellas: Research Contractor , Research support and Speaker honorarium
Merck: Honorarium , Speaker honorarium
Cidara: Honorarium , Speaker honorarium
Amplyx: Honorarium , Speaker honorarium
F2G: Honorarium , Speaker honorarium

G. R. Thompson, None

A. Reboli, None

K. W. Garey, None

R. N. Greenberg, None

L. Ostrosky-Zeichner, Astellas: Consultant and Grant Investigator , Consulting fee and Research grant
Merck: Scientific Advisor and Speaker's Bureau , Consulting fee and Speaker honorarium
Pfizer: Grant Investigator and Speaker's Bureau , Grant recipient and Speaker honorarium
Scynexis: Grant Investigator and Scientific Advisor , Consulting fee and Grant recipient
Cidara: Grant Investigator and Scientific Advisor , Consulting fee and Research grant

A. Wu, None

G. M. Lyon III, None

S. Apewokin, T2 biosystems: Investigator , Research support
Astellas: Scientific Advisor , Consulting fee

M. H. Nguyen, None

A. Caliendo, None

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