4.7 Article

T2Candida MR as a predictor of outcome in patients with suspected invasive candidiasis starting empirical antifungal treatment: a prospective pilot study

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JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY
卷 73, 期 -, 页码 6-12

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OXFORD UNIV PRESS
DOI: 10.1093/jac/dky047

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资金

  1. PROgrama MULtidisciplinar para la Gestion de Antifungicos y la Reduccion de Candidiasis Invasora (PROMULGA) II Project
  2. Instituto de Salud Carlos III Madrid Spain
  3. European Regional Development Fund (FEDER) [PI13/01148, CM15/00181]
  4. T2 Biosystems

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Objectives: We assessed the potential role of T2Candida MR (T2MR) and serological biomarkers [beta-D-glucan (BDG) or Candida albicans germtube antibodies (CAGTA)], alone or in combination with standard cultures, for identifying patients with suspected invasive candidiasis (IC), whomay benefit from maintaining antifungal therapy. Methods: Prospective observational multicentre study including all adult patients receiving empirical antifungal therapy for suspected IC, from January to June 2017. CAGTA, BDG and T2MR were determined at baseline and at ! 2 and ! 4 days after enrolment. Primary endpoint was the diagnostic value of CAGTA, BDG and T2MR, alone or in combination with standard culture, to predict diagnosis of IC and/or mortality in the first 7 days after starting antifungal therapy (poor outcome). Results: Overall, 14/49 patients (28.6%) had a poor outcome (7 died within the first 7 days of antifungal therapy, whereas 7 ended with a diagnosis of IC). CAGTA [3/14 (21.4%) versus 8/35 (22.9%), P-1] and BDG [8/14 (57.1%) versus 17/35 (48.6%), P = 0.75] results were similar in poor-and good-outcome patients. Conversely, a positive T2MR was associated with a higher risk of poor outcome [5/14 (35.7%) versus 0/35 (0.0%) P = 0.0001]. Specificity and positive predictive value of a positive T2MR for predicting poor outcome were both 100%, with a negative predictive value of 79.6%. After testing the combinations of biomarkers/standard cultures and T2MR/standard cultures, the combination of T2MR/standard cultures showed a high capacity to discriminate patients with poor outcome from those with good clinical evolution. Conclusions: T2MR may be of significant utility to identify patients who may benefit from maintaining antifungal therapy.

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