Purpose: Candidemia is a critical contributor to morbidity following solid organ transplantation (SOT). The purpose of this study is to evaluate the T2Candida assay (T2) for diagnosis of candidemia and impact on duration of therapy in patients with and without candidemia following SOT.

Methods: T2 was performed at our center 945 times in patients with or without SOT from 1/2016 through 10/2017. SOT recipients from this cohort and/or with candidemia were identified and chart review was performed for demographics, date and organ of transplant, time to effective therapy (hours), and duration of empiric therapy (days). The T2 is a PCR-based, whole-blood assay with a sensitivity of 91.1% and specificity of 99.4% for the detection of five Candida species.

Results: During the study period, there were 66 tests in SOT recipients, of which 4 (6.3%) were positive. Patient details in Table 1. Three positive results were with concurrent negative blood cultures. Of the 61 true negative T2 tests, 54 were used as evidence to stop or withhold anti-Candida therapy resulting in an average of 1.98 days of empiric treatment. In comparison, the average length of empiric therapy for candidemia without evidence of disease at our institution during 2015-2016 was 6.35 days. In addition, candidemia was diagnosed by blood cultures in 9 SOT patients, only two also had a T2 result – one true positive and one false negative. The average time to effective therapy in these 9 patients was 26 hours. Four patients were started on therapy empirically within the first 24 hours. The remaining five patients were not started on therapy until after blood cultures were reported positive for yeast with a mean time to therapy of 44 hours (range: 33-71 hours).

Conclusions The T2Candida assay allows the opportunity to target therapy earlier for those with infection as well as stop empiric therapy in those without it. This combination allows both improved care and limited empiric antifungal usage.

CITATION INFORMATION: McCarty T., Baddley J., Locke J., Mannon R., Eckhoff D., Rusanov V., Moser S., Pappas P. T2Candida for Diagnosis of Candidemia in Solid Organ Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

« Back to 2018 American Transplant Congress