Clinical Utility of the T2Candida NPV

57 year old male transferred to long-term acute care (LTAC) facility for long-term ventilatory support and rehabilitation

Discussion

This case highlights how the high negative predictive value (NPV) of the T2Candida Panel enables the ability rule out the five most common Candida species in a clinical setting. In this case, because of the rapid negative result, antifungal therapy could be de-escalated early in the patient’s course.

Presentation

57 year old male transferred to long-term acute care (LTAC) facility for long-term ventilatory support and rehabilitation. On Day 6 of admit to LTAC, the patient spiked fever of 100.9 F with increased oxygen requirements and drainage from enterocutaneous fistula. Patient has history of penetrating abdominal trauma, tracheostomy and multiple re-explorations/evacuations of intra-abdominal abscesses, partial gastrectomy, and placement of abdominal wound VACs. 

Patient Selection Criteria

Multiple abdominal surgeries, empiric use of micafungin

Evaluation and Treatment

Diagnosis: Sepsis from intra-abdominal infection and/or possible pneumonia

Empiric Therapy: The patient was switched from ceftriaxone to imipenem/cilastatin, vancomycin, and micafungin for suspected abdominal sepsis and possible pneumonia.

Blood Culture Result: No growth

Tracheal Aspirate Culture Result: No growth

Urine Culture: Vancomycin-resistant Enterococcus faecium

T2Candida Panel Result: Negative for the five target pathogens

Decision making based on the T2Candida Result

T2Candida was negative, therefore micafungin was discontinued after only a single dose.

Blood and sputum cultures demonstrated ‘no growth’ after 48 hours. Urine culture was positive for VRE, so vancomycin was switch to linezolid on day 3 of antimicrobial therapy. Patient completed a course of antibacterials x 10 days total.

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  • According to the CDC, of the 154 million prescriptions for antibiotics written in doctors' offices and emergency departments each year, 30% are unnecessary.12