Epidemiology of bloodstream Candida species in a Spanish tertiary care hospital as a guide for implementation of T2MR (T2CANDIDA®) for rapid diagnosis of candidemia

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:label /> <jats:p>The aim of this work was to study the epidemiology of candidemia in our hospital in order to determine whether the T2MR system might be a useful tool for early diagnosis of candidemia in selected units. We perform a retrospective review of all candidemia episodes registered in the last 12 years in selected units of our hospital in adult and pediatric patients. Candida species and antifungal susceptibility patterns were registered. A total of 686 isolates were registered, of which 625 were infections due to the five most common species of Candida. C. albicans (45.6%) and C. parapsilosis (33.1%) were the predominant species found in our institution. In adults these species were closely followed by C. glabrata (12–21%) in all units. While in pediatric medical and intensive care units (PICU), these species were followed by other uncommon yeasts. Resistance rates to triazoles were low in C. albicans and C. parapsilosis. In C. glabrata and C. tropicalis the resistance rates to fluconazole ranged from 10.86 to 6.67%. Resistance rates for echinocandins were very low and all strains were susceptible to amphotericin B. T2Candida® might be useful to guide antifungal targeted treatment and discontinuation of antifungal empirical treatment in those units where the five most common Candida species represent more than the ninety percent of the isolates. The selection of medical and surgical units should be based on local epidemiology and antifungal susceptibility patterns. Incidence should be taken into account in order to make clinical decisions based on negative results.</jats:p> </jats:sec> <jats:sec> <jats:title>Lay Abstract</jats:title> <jats:p>T2Candida® might be useful selectively in clinical units according to their local epidemiology, antifungal resistance patterns, and incidence of candidemia. It optimizes the clinical value of positive results supporting decisions about targeted therapies or discontinuations based on negative results.</jats:p> </jats:sec>

T2MR can be used as a non-culture-based test together with biomarkers to improve detection of Candida in the bloodstream and reduce time delay in treating invasive candidiasis

“…In addition, MAg or BDG may signal clearance of infection and thus guide duration of treatment, which T2MR cannot do alone because it remains positive for a longer time [7,12,13]. In conclusion, T2MR may have selective utility in clinical units according to local epidemiology, antifungal resistance patterns and incidence of IC and candidemia [14]. Further studies are needed to determine the utility of T2MR, alone or in combination with other tests such as MAg and BDC for diagnosis and prognosis of IC in ICU patients.…”

T2Candida for the Diagnosis and Management of Invasive Candida Infections

“…and may limit its applicability [26,28]. A recent review of 686 Candida blood isolates collected over a 12-year period in Spain found that 91% were those included in the T2Candida panel [46]. In adult units, C. albicans, C. parapsilosis, and C. glabrata accounted for 91-100% of all isolates whereas in pediatric units, C. albicans and C. parapsilosis were frequent [46].…”

“…A recent review of 686 Candida blood isolates collected over a 12-year period in Spain found that 91% were those included in the T2Candida panel [46]. In adult units, C. albicans, C. parapsilosis, and C. glabrata accounted for 91-100% of all isolates whereas in pediatric units, C. albicans and C. parapsilosis were frequent [46]. The selection of centers for T2Candida implementation should account for local epidemiology and distribution of Candida sp.…”

Early Empirical Anidulafungin Reduces the Prevalence of Invasive Candidiasis in Critically Ill Patients: A Case-control Study

“…Over the last few decades, researchers found reduced rate of hospital mortality with adequate empirical antibacterial therapies. Few studies were conducted successfully to evaluate the outcomes of early initiating antifungal therapies in critically ill patients [ 11 , 12 , 13 , 14 ]. Some studies illustrated that early appropriate antifungal therapies reduce the rate of mortality with improved clinical outcomes in critically ill patients [ 1 , 13 , 14 ].…”

“…Few studies were conducted successfully to evaluate the outcomes of early initiating antifungal therapies in critically ill patients [ 11 , 12 , 13 , 14 ]. Some studies illustrated that early appropriate antifungal therapies reduce the rate of mortality with improved clinical outcomes in critically ill patients [ 1 , 13 , 14 ]. Some experts gave importance on the use of appropriate antifungal therapies empirically in high-risk critically ill patients [ 13 , 15 , 16 ].…”