T2Candida for the Diagnosis and Management of Invasive Candida Infections

Abstract

Invasive candidiasis is a common healthcare-associated infection with high mortality and is difficult to diagnose due to nonspecific symptoms and limitations of culture based diagnostic methods. T2Candida, based on T2 magnetic resonance technology, is FDA approved for the diagnosis of candidemia and can rapidly detect the five most commonly isolated Candida sp. in approximately 5 h directly from whole blood. We discuss the preclinical and clinical studies of T2Candida for the diagnosis of candidemia and review the current literature on its use in deep-seated candidiasis, its role in patient management and prognosis, clinical utility in unique populations and non-blood specimens, and as an antifungal stewardship tool. Lastly, we summarize the strengths and limitations of this promising nonculture-based diagnostic test.

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

“…A recent multicenter study, reported by Monday et al [15], isolated mixed yeast infections in approximately 2% of cultures from sterile sites. The paired reporting of T2MR results (i.e., C. albicans/C.…”

“…T2MR does not provide antifungal susceptibility data but the combination of MAg together with T2MR identified all isolates [11]. It remains unclear how to clinically interpret the approximately 30% of cases that have positive T2Candida with negative BCs [4,6,15]. BCs can detect 1 CFU/mL of most Candida sp.…”

“…Limited data show that T2MR may serve as a surrogate marker for deep-seated candidiasis and intra-abdominal candidiasis, especially in cases with negative blood cultures or when invasive procedures cannot be performed to obtain specimens for testing from deep-seated sites of infection [10,11,15]. This remains an area of uncertainty that will need more research.…”

“…The value of the T2MR technique probably depends on patients' characteristics. In ICU, utilization of T2MR for identification of bloodstream pathogens provides faster time to detection, faster transition to target therapy, faster de-escalation of empirical therapy, shorter ICU and hospital stay, and with comparable mortality rate versus BC [15].In pediatrics, to date, galactomannan and 1,3 β-D-glucan assays are the most efficient non-culture methods for diagnosis and monitoring of antifungal therapy though other new technologies are applied, such as T2MR assays [4,5]. However, these are not standardized or validated in children [15].…”

“…Early antifungal therapy has shown its usefulness as it decreases mortality in severe patients [1]. Similarly, T2MR seems of value in de-escalation of antifungals and leads to cost savings [15]. In conclusion, non-culture Candida diagnostics have potential to advance patient care, but this promise will be realized only if users understand tests' strengths and limitations, and plan proactively how best to employ them in their hospitals [8].…”