Resistance

Empiric therapy has become a growing practice

While waiting for results from blood culture-based diagnostics, patients considered at high risk for candidemia are being treated with unnecessary antifungals at an increasing rate. It is estimated that 40% of high-risk, symptomatic patients are on this empiric therapy for 1 to 15 days, whether or not they even have a Candida infection.1 However, empiric treatment is unnecessary for over 97% of patients.1 Empiric therapy has become a growing practice because, prior to T2Candidathere had not been a diagnostic test available that could provide accurate test results to aid clinical decision making.

Resistance is a serious health threat

Due to the empiric therapy so often provided and not needed, antifungal resistance continues to grow and complicate patient management. Antifungal resistance is associated with elevated minimum inhibitory concentrations (MICs), poorer clinical outcomes, and breakthrough infections during antifungal treatment and prophylaxis.2 And now, clinical standards support empiric treatment with echinocandins for high risk patients while waiting for blood culture results. Candidemia due to Candida glabrata is becoming increasingly common, and C. glabrata isolates are increasingly resistant to both azole and echinocandin antifungal agents.2

The CDC has declared antifungal resistance a serious health threat. Most alarming is that no new “class” of antifungal options are on the horizon.

Now the only reason to treat patients for Candida will be because they actually have it

Unlike blood culture-based diagnostics, the T2Candida Panel provides species-specific results direct from whole blood in an average of 4.3 hours versus 2-6 days with 91.1% sensitivity and 99.4% specificity.3 In a patient population with a 3% disease prevalence, the negative predictive value (NPV) of the T2Candida Panel is 99.7%!

With a NPV of 99.7%, a rapid negative test result from the T2Candida Panel may enable physicians to stop unnecessary antifungal treatment which saves money, reduces toxicity and lowers the risk of antimicrobial resistance in the hospital. 

 

What we need is a test that is 90% sensitive and 90% specific. That’s the test that makes a difference. If you’re at 90/90 then the negative predictive value is exceptional in virtually every population you use it in…that’s really clinically the most meaningful performance that we can achieve. 
Cornelius J. Clancy, MD, Associate Professor of Medicine, Director, Mycology Program, University of Pittsburgh, Pittsburgh, PA

 

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1. Aitken S.L., Beyda N.D., Shah D.N., et al. Clinical practice patterns in hospitalized patients at risk for invasive candidiasis: role of antifungal stewardship programs in an era of rapid diagnosticsAnnals of pharmacotherapy, 48(6), 683-690.
2. Pfaller et al. Mycoses 2014; 57:602-11
style="margin-left: 0.25in;"> 3. Mylonakis, E., Clancy, C.J., Ostrosky-Zeichner, et. al. (2015). T2 Magnetic Resonance Assay for the Rapid Diagnosis of Candidemia in Whole Blood: A Clinical TrialClinical infectious diseases, ciu959.
3. Mylonakis, E., Clancy, C.J., Ostrosky-Zeichner, et. al. (2015). T2 Magnetic Resonance Assay for the Rapid Diagnosis of Candidemia in Whole Blood: A Clinical TrialClinical infectious diseases, ciu959.