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Background: Candidemia is associated with mortality rates between 30 and 50%. T2 magnetic resonance assay (T2MR) is a costly, rapid diagnostic technology that can detect the five most common Candida species in blood with a sensitivity of 91% and specificity of 99.4%. The clinical role of this tool remains unclear but this study shares our clinical experience with T2MR.
Methods: We conducted a retrospective chart review of patients with T2MR testing performed from April 25, 2017 through April 25, 2018. T2MR ordering was restricted to Infectious Diseases pharmacists and physicians without specific ordering criteria. Variables cataloged included the time between order and result in the medical chart, T2MR result, anti-fungal therapy and duration. Descriptive statistics were reported on collected variables.
Results: Sixty-eight unique patients had T2MR ordered at least once during the study time period. The median age was 62.5 years (interquartile range (IQR), 22–92) and 42 patients (62%) were male. The median time between order and result appearing in the medical chart was 6.21 hours (IQR, 3.55–40.93). Out of 72 tests performed, 4 were positive (2 for C. parapsilosis and 2 for C. krusei/glabrata). Only 1 of 4 T2MR positive patients had concurrent candidemia while 1 patient had suspected fungal endophthalmitis, 1 patient was managed for a fistula, and 1 patient had cutaneous candidiasis. Of the negative tests, 1 patient had a false negative T2MR result despite blood cultures growing C. glabrata. There was only 1 invalid test in our sample. Thirty-six patients were initiated or maintained on anti-fungal therapy at the time of the T2MR test, with micafungin being the most commonly prescribed anti-fungal agent. Negative T2MR patients had a median anti-fungal therapy duration of 2 days (IQR, 0–16). Sixteen patients (44%) had their anti-fungal therapy discontinued within 1 day of the negative T2MR result. There were no patients with a negative T2MR result who subsequently developed candidemia within 30 days after T2MR testing.
Conclusion: Our study showcases the benefit seen with T2MR in curtailing unnecessary anti-fungal exposure. Study limitations include a small cohort and evaluation at a single center. There is an opportunity for this technology to be utilized in anti-fungal stewardship.
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Citation / Publisher Attribution
Open Forum Infectious Diseases, v. 6, issue Supplement_2, p. S149-S150
Scholar Commons Citation
Jariwala, Ripal; Zeitler, Kristen; and Montero, Jose, "T2MR: A New Tool for Anti-Fungal Stewardshi" (2019). Internal Medicine Faculty Publications. 173.