T2 Magnetic Resonance Assay for the Rapid Diagnosis of Candidemia in Whole Blood: A Clinical Trial

Mylonakis, Eleftherios; Clancy, Cornelius J.; Ostrosky-Zeichner, Luis; Garey, Kevin W.; Alangaden, George; Vázquez, José Antonio; Groeger, Jeffrey S.; Judson, Marc A.; Vinagre, Yuka Marie; Heard, Stephen O.; Zervou, Fainareti N.; Zacharioudakis, Ioannis M.; Kontoyiannis, Dimitrios P.; Pappas, Peter G.

doi:10.1093/cid/ciu959

Cited by 368 publications

(242 citation statements)

References 39 publications

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“…Sensitivities reached 98% when blood culture was combined with PCR. A whole blood assay combining PCR technology and nanoparticle-based hybridization (T2 magnetic resonance) was recently shown to rapidly (<5 h), accurately, and reproducibly detect 1-3 CFU of C. albicans, C. tropicalis, C. glabrata, C. krusei, and C. parapsilosis per milliliter of spiked blood or in patients with a low incidence of IC [73]. Lately, a PCR/electrospray ionization-mass spectrometry (PCR/ ESI) technology was developed to detect more than 800 bloodstream infection-relevant bacterial and Candida species within 6 h of sample acquisition.…”

Section: What Are Remaining Areas Of Uncertainty? Invasive Candidiasismentioning

confidence: 99%

“…in blood cultures within a few hours are highly attractive, but clinical studies are needed to establish the clinical benefits of these diagnostic tools and how to introduce them into the diagnostic work-up. T2 diagnostic technology is an exciting development in the field, but more realworld experience is needed [73,79].…”

Section: What Are Remaining Areas Of Uncertainty? Invasive Candidiasismentioning

confidence: 99%

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Intensive care medicine research agenda on invasive fungal infection in critically ill patients

et al. 2017

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Purpose:To describe concisely the current standards of care, major recent advances, common beliefs that have been contradicted by recent trials, areas of uncertainty, and clinical studies that need to be performed over the next decade and their expected outcomes with regard to Candida and Aspergillus infections in non-neutropenic patients in the ICU setting. Methods:A systematic review of the medical literature taking account of national and international guidelines and expert opinion. Results:Severe invasive fungal infections (IFIs) are becoming increasingly frequent in critically ill patients. Approximately 80% of IFIs are due to Candida spp. and 0.3-19% to Aspergillus spp. Recent observations emphasize the necessity of building a worldwide sentinel network to monitor the emergence of new fungal species and changes in susceptibility. Robust data on the attributable mortality are essential for the design of clinical studies with mortality endpoints. Although early antifungal therapy for Candida has been recommended in patients with risk factors, sepsis of unknown cause, and positive Candida serum biomarkers [β-1 → 3-d-glucan (BDG) and Candida albicans germ tube antibody (CAGTA)], its usefulness and influence on outcome need to be confirmed. Future studies may specifically address the optimal diagnostic and therapeutic strategies for patients with abdominal candidiasis. Better knowledge of the pharmacokinetics of antifungal molecules and tissue penetration is a key issue for intensivists. Regarding invasive aspergillosis, further investigation is needed to determine its incidence in the ICU, its relationship with influenza outbreaks, the clinical impact of rapid diagnosis, and the significance of combination treatment. Conclusions:Fundamental questions regarding IFI have to be addressed over the next decade. The clinical studies described in this research agenda should provide a template and set priorities for the clinical investigations that need to be performed.

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Section: What Are Remaining Areas Of Uncertainty? Invasive Candidiasismentioning

confidence: 99%

Section: What Are Remaining Areas Of Uncertainty? Invasive Candidiasismentioning

confidence: 99%

Intensive care medicine research agenda on invasive fungal infection in critically ill patients

et al. 2017

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“…54 Another promising assay is the T2Candida Panel (T2 Biosystems), a US Food and Drug Administration (FDA)-cleared test to detect 5 species of Candida directly from whole blood without need for culture or nucleic acid extraction within 3 to 5 hours (Table 1). 55 In their appraisal of clinical studies to date, Pfaller and colleagues noted that the T2Candida Panel also detected all 12 confirmed cases of deep-seated infections in patients with negative blood cultures, suggesting a potential role to diagnose previously unrecognized Candida infections. 56 Additional studies are certainly warranted to see if PCR, BDG, or T2Candida Panel can improve antifungal utilization and patient outcomes for IC, but their benefits may not be fully realized if there is absence of real-time AS intervention.…”

Section: Improving Diagnosis Of Invasive Candidiasismentioning

confidence: 99%

Antifungal stewardship considerations for adults and pediatrics

2016

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Antifungal stewardship refers to coordinated interventions to monitor and direct the appropriate use of antifungal agents in order to achieve the best clinical outcomes and minimize selective pressure and adverse events. Antifungal utilization has steadily risen over time in concert with the increase in number of immunocompromised adults and children at risk for invasive fungal infections (IFI). Challenges in diagnosing IFI often lead to delays in treatment and poorer outcomes. There are also emerging data linking prior antifungal exposure and suboptimal dosing to the emergence of antifungal resistance, particularly for Candida. Antimicrobial stewardship programs can take a multi-pronged bundle approach to ensure suitable prescribing of antifungals via postprescription review and feedback and/or prior authorization. Institutional guidelines can also be developed to guide diagnostic testing in at-risk populations; appropriate choice, dose, and duration of antifungal agent; therapeutic drug monitoring; and opportunities for de-escalation and intravenous-to-oral conversion.

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“…In particular, the cost-effectiveness and usefulness of the Candida colonization status, a work-intensive strategy, for the management of ICU patients at risk for IC has not yet been demonstrated, and the current study clearly suggests that it should not be used on a routine basis. Future molecular tests that enable diagnosis of fungal bloodstream infections directly from whole blood may be more suited to trigger targeted antifungal therapy many days in advance of traditional culture-based methods without unnecessary treatment of patients at risk who will ultimately not progress to IC (19).…”

Section: Candida Colonizationmentioning

confidence: 99%

The EMPIRICUS trial—the final nail in the coffin of empirical antifungal therapy in the intensive care unit?

Osthoff

Khanna

Siegemund³

2017

J. Thorac. Dis.

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T2 Magnetic Resonance Assay for the Rapid Diagnosis of Candidemia in Whole Blood: A Clinical Trial

Abstract: NCT01752166.

Cited by 368 publications

References 39 publications

Intensive care medicine research agenda on invasive fungal infection in critically ill patients

Intensive care medicine research agenda on invasive fungal infection in critically ill patients

Antifungal stewardship considerations for adults and pediatrics

The EMPIRICUS trial—the final nail in the coffin of empirical antifungal therapy in the intensive care unit?

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