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What Is New in Candida Infections? T2Candida, Antifungal Stewardship, and Candida auris

  • Fungal Infections (O De la Cruz and F Silveira, Section Editors)
  • Published:
Current Treatment Options in Infectious Diseases Aims and scope Submit manuscript

Abstract

Purpose of review

We review T2Candida panel performance in diagnosing invasive candidiasis, potential roles of T2Candida, and other culture-independent tests in patient management and antifungal stewardship, and diagnosis and treatment of infections by Candida auris, which has emerged globally as a cause of nosocomial outbreaks.

Recent findings

In 2 multicenter trials, T2Candida was 90% sensitive and 98% specific for diagnosing candidemia directly from whole blood samples. A subsequent study demonstrated T2Candida sensitivity/specificity of 45%/96% for diagnosing deep-seated candidiasis. Other studies have shown that ongoing T2Candida positivity was associated with poor patient outcomes, and T2Candida targeted to patients at risk for invasive candidiasis was useful in guiding antifungal treatment and stewardship decisions. C. auris is misidentified by commercial biochemical and matrix-assisted laser desorption ionization time-of-flight mass spectrometry systems that do not include the species in their databases. In different studies, a T2Candida research assay was 89% sensitive and 98% specific in identifying C. auris in clinical axilla or groin swab samples, and serum β-D-glucan sensitivity and specificity for diagnosing invasive infections by C. auris and other species were comparable. Fluconazole, amphotericin B, and echinocandin resistance rates among C. auris isolates are > 90%, ~ 30%–40%, and ~ 3%–10%, respectively. Echinocandins are agents of choice against most C. auris infections.

Summary

Since T2Candida results assign a probability of invasive candidiasis based on pre-test disease likelihood, the test will only have value if directed toward at-risk patients. Rapid and accurate tests for detecting C. auris are needed for surveillance and diagnostic purposes.

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Acknowledgments

Drs. Clancy and Nguyen received no assistance in writing this paper.

Author information

Authors and Affiliations

  1. Department of Medicine, Division of Infectious Diseases, University of Pittsburgh, Scaife Hall 867, 3550 Terrace St., Pittsburgh, PA, 15620, USA

    Cornelius J. Clancy M.D. & M. Hong Nguyen M.D.

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  1. Cornelius J. Clancy M.D.
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Corresponding author

Correspondence to Cornelius J. Clancy M.D..

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Conflict of Interest

Dr. Clancy has been awarded investigator-initiated research grants from T2Biosystems, Astellas, Merck, Melinta, and Cidara for projects unrelated to this study, served on advisory boards or consulted for Astellas, Merck, the Medicines Company, Cidara, Scynexis, Shionogi, Qpex, and Needham & Company, and spoken at symposia sponsored by Merck and T2Biosystems. Dr. Nguyen has been awarded investigator-initiated research grants from T2Biosystems, Astellas, Merck, Melinta, and Cidara for projects unrelated to this study, and served on advisory boards for Astellas, Merck, the Medicines Company, Scynexis, and Shionogi.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Keypoints

• In recent studies, T2Candida sensitivity/specificity for diagnosing candidemia and deep-seated (primarily intra-abdominal) candidiasis were 90%/98% and 45%/96%, respectively, and persistent T2Candida positivity was associated with poor prognosis.

• If targeted to carefully chosen patients who are at-risk for invasive candidiasis, T2Candida and other culture-independent diagnostic tests can be useful in guiding antifungal treatment and stewardship.

• CIDT research priorities include (a) clinical trials of T2Candida—and other CIDT-guided therapeutic strategies that demonstrate impact on patients’ outcomes, antifungal utilization, and cost-effectiveness; (b) studies of CIDT performance in blood culture-negative, deep-seated candidiasis; and (c) reports from centers using T2Candida and other CIDTs in routine clinical practice and antifungal stewardship.

• Healthcare professionals must be aware of the epidemiology and global spread of C. auris, and make plans for its detection and multidisciplinary responses to its introduction into their facilities.

• C. auris isolates are almost universally resistant to fluconazole and may be resistant to other antifungal drugs, and echinocandins usually are the preferred therapeutic agents.

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Clancy, C.J., Nguyen, M.H. What Is New in Candida Infections? T2Candida, Antifungal Stewardship, and Candida auris. Curr Treat Options Infect Dis 12, 1–12 (2020). https://doi.org/10.1007/s40506-020-00209-6

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