2043. T2-Candida (T2MR) versus Beta-D-Glucan (BDG) for Preemptive Antifungal Stewardship in the Intensive Care Unit (ICU)
Session: Poster Abstract Session: Diagnostics: Mycology
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • ID Week Poster CGill Neg T2 AF stewardship 9.25.18 Final.pdf (189.5 kB)
  • Background: Timely empiric antifungal therapy is essential in the management of candidemia but must be weighed with the risks of overuse. The purpose of this study was to compare preemptive antifungal therapy and outcomes following a negative T2MR or BDG test result among ICU patients.

    Methods: IRB-approved, quasi-experiment in a four hospital system, May 2014-Oct 2017. T2MR implemented Nov 2015. Inclusion: preemptive anidulafungin (AFG), negative blood culture(s) and either a negative BDG by system guideline interpretation or T2MR. Exclusions: transplant, neutropenia, or another documented indication for antifungals. Primary endpoint: days of preemptive AFG. Secondary outcomes: ICU and hospital length of stay, incidence of invasive candidiaisis after discontinuation of preemptive therapy, reinitiation of antifungal therapy in the index admission, and inpatient mortality. Early discontinuation defined as single dose only.

    Results: 179 patients included: BDG n=79, T2MR n=100. Median age: BDG 63 (50, 71); T2MR 59 (50, 70). Baseline SOFA Score: 8 (6,11) BDG; 12 (8,15) T2MR. Candida score >= 3: 43 and 41%, respectively. Preemptive AFG: 2 (1,5) days BDG and 1 (1,2) days T2MR (P < 0.001). Subsequent proven candidemia:2 (2.5%) BDG; 1 (1%) T2MR. Antifungal reinitiated: 13 (17%) BDG; 12 (12%) T2MR. Mortality: 35 (44%) BDG, 59 (59%) T2MR, p=0.07. AFG was discontinued early in 91 (51%) patients. T2MR was the only characteristic associated with early D/C (Table 1).

    Conclusion: T2MR testing facilitates use of early preemptive echinocandin therapy in ICU patients and minimizes unnecessary prolonged therapy when compared to use of BDG.

    Table 1. Early discontinuation

    Early D/C (n=91)

    Continuation (n=88)

    UnadjOR (95%CI)

    T2MR

    59 (65%)

    41 (47%)

    2.1 (1.2 – 3.9)

    SOFA > 7

    74 (81%)

    70 (79%)

    1.1 (0.5 – 2.3)

    Vasopressors

    45 (50%)

    50 (57%)

    0.7 (0.4 – 1.3)

    Candida score >=3

    35 (39%)

    40 (46%)

    0.8 (0.4 – 1.4)

    Severe sepsis

    86 (95%)

    82 (93%)

    1.3 (0.4 – 2.3)

    Surgery

    25 (28%)

    30 (34%)

    0.7 (0.4 – 1.4)

    TPN

    7 (8%)

    11 (13%)

    0.6 (0.2 – 1.6)

    Multifocal colonization

    7 (8%)

    12 (14%)

    0.5 (0.2 – 1.4)

    Christian Gill, PharmD1, Laura Hencken, PharmD, BCCCP1, Mark Mlynarek, RPh, BCPS1, George Alangaden, MD, FIDSA2, Linoj Samuel, PhD., D(ABMM)3, Rachel Kenney, PharmD1 and Susan L Davis, PharmD4, (1)Pharmacy, Henry Ford Hospital, Detroit, MI, (2)Infectious Diseases, Henry Ford Health System, Detroit, MI, (3)Microbiology, Henry Ford Hospital, Detroit, MI, (4)Pharmacy Practice, Wayne State University, Detroit, MI

    Disclosures:

    C. Gill, None

    L. Hencken, None

    M. Mlynarek, None

    G. Alangaden, T2 Biosystems: Speaker's Bureau , Educational grant and Speaker honorarium .

    L. Samuel, None

    R. Kenney, None

    S. L. Davis, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.