T2Candida and potential antifungal use optimization in medical ICU patients in septic shock

Reviewed by: Jose Lucar, MD, The George Washington University

Candidemia is associated with a high attributable mortality, and better diagnostics are needed to improve patient outcomes and optimize antifungal use. In this single-center, retrospective study, the authors assessed the role of diagnostic stewardship program-guided T2Candida assay to evaluate time to antifungal initiation and overall antifungal use among adult medical ICU (mICU) patients in septic shock. Patients with positive T2Candida testing were compared with mICU patients who did not undergo T2Candida testing but had septic shock and blood cultures positive for Candida. A total of 143 patients underwent 155 T2Candida tests, 9% of which were positive compared to 4.5% of blood cultures, with a median time between blood culture collection and T2Candida testing of 7.9 (IQR, 0-19.5) hours. Patients who tested positive for T2Candida were diagnosed earlier and started on antifungal therapy sooner than controls, while median antifungal days of therapy/1000 patient-days decreased compared to the preintervention period. This study lays the groundwork for future prospective studies and underscores the potential impact of dedicated diagnostic stewardship resources to optimize the role of rapid diagnostic assays.  

O’Donnell M, Shields RK, Marini RV, et al. Stewardship-Guided T2Candida Testing Shortens Time to Antifungal Treatment and Reduces Antifungal Usage Among Medical Intensive Care Unit Patients With Septic Shock. Open Forum Infect Dis. 2023 Nov 8;10(11):ofad538.

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