The Deadly Fungal Infections You Should Know & How to Diagnose Them

Fungal bloodstream infections, primarily those caused by Candida species, are the fourth most common bloodstream infection in the United States and Europe's eighth most common ICU-acquired bloodstream infection.[1,2] A Candida bloodstream infection, also called candidemia, is the most common form of invasive candidiasis (IC). There are many Candida species that have been identified to cause infections in humans; however, >90% of IC are caused by 5 pathogens, Candida albicans, Candida glabrata, Candida tropicalis, Candida parapsilosis, and Candida krusei.[3] ?

Epidemiology of Invasive Candidiasis ?

Candida is the most frequent cause of #fungal #sepsis or fungal septic shock in nosocomial bloodstream infections (BSIs), particularly in the intensive care units (ICUs)[4]. A recent registry study noted that the proportion of non-Candida albicans infections was increasing and was higher than that caused by Candida albicans infections (57.9 vs. 42.1%, respectively)[5]. Additionally, several retrospective studies involving patients with a variety of diseases with candidemia had revealed significant morbidity and crude, attributable mortality rates of anywhere from 30%–81% and 5%–71%, respectively.[5-9] ?

The administration of early and effective #antifungal therapy has been documented as an important strategy to improve the survival of candidemia.[8,10] One study verified that patients who received antifungal therapy less than 24 hours from candidemia onset had a 15.4% mortality rate versus patients who were delayed greater than 72 hours and had a 41% mortality rate.[8] ?Empiric therapy does not guarantee appropriate therapy for affected candidemic patients. ?

Increased use of empiric antifungals in this population has been shown to limit blood culture sensitivity in infected patients and also expose non-infected patients to unnecessary antifungal therapy contributing to adverse drug effects and likely contributing to antifungal resistance.[11,12] With the noted rise in antifungal use, it is estimated that approximately 3% of all hospital admission and 8% of ICU admissions include antifungal administration.[13] Additionally, it is estimated that as many as 50% of this antifungal use is inappropriate.?

Diagnosis of Invasive Candidiasis ?

Blood cultures remain the gold standard for the detection of candidemia, however, are limited for diagnosing IC due to their poor sensitivity and slow time to growth and subsequent species identification. It has been acknowledged that blood cultures may miss approximately 50% of episodes of invasive candidiasis.[14] These limitations of conventional diagnostic methods may delay the initiation of antifungals and have urged the development of alternative, culture-independent diagnostic tests for candidiasis. Currently, the only FDA-approved blood culture-independent diagnostic test that can provide identification of the 5 most common Candida species is T2 Biosystems ' T2Candida? Panel .?

White Paper: T2Candida for Critically Ill Patients: Clinical Outcomes, Testing, and Treatment Algorithms?

Given the high attributable mortality and challenges with conventional diagnostic methods, the need for improved rapid diagnostics for Candida species is evident.? T2Candida is uniquely positioned to meet this need. T2Candida has been shown to be a highly sensitive and specific test in clinical trials.? T2Candida has been deployed in clinical care in a variety of settings and has been shown to improve clinical care and advance antifungal stewardship goals. Read this white paper containing clinical trial data, real-world evidence, and example algorithms that detail the ways that T2Candida can be incorporated into practice and improve care for invasive candidiasis in your own practice.??

Additional Resources

For more information regarding the clinical utility of the T2Candida Panel, watch the webinar , "Lessons for Diagnosing and Managing Candidiasis in Critically Ill Patients," with speaker Dr. Cornelius Clancy from UPMC.

References:

1. Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis 2004;39:309-17.?
2. Healthcare-associated infections acquired in intensive care units: annual epidemiological report for 2017. Europen Centre for Disease Prevention and Control. 2017. ?
3. Pappas PG, Kauffman CA, Andes DR, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016;62:e1-50.?
4. Kollef M, Micek S, Hampton N, Doherty JA, Kumar A. Septic shock attributed to Candida infection: importance of empiric therapy and source control. Clin Infect Dis 2012;54:1739-46?
5. Pfaller M, Neofytos D, Diekema D, et al. Epidemiology and outcomes of candidemia in 3648 patients: data from the Prospective Antifungal Therapy (PATH Alliance(R)) registry, 2004-2008. Diagn Microbiol Infect Dis 2012;74:323-31.?
6. Chen S, Slavin M, Nguyen Q, et al. Active surveillance for candidemia, Australia. Emerg Infect Dis 2006;12:1508-16.?
7. Morgan J, Meltzer MI, Plikaytis BD, et al. Excess mortality, hospital stay, and cost due to candidemia: a case-control study using data from population-based candidemia surveillance. Infect Control Hosp Epidemiol 2005;26:540-7.?
8. Garey KW, Rege M, Pai MP, et al. Time to initiation of fluconazole therapy impacts mortality in patients with candidemia: a multi-institutional study. Clin Infect Dis 2006;43:25-31.?
9. Horn DL, Neofytos D, Anaissie EJ, et al. Epidemiology and outcomes of candidemia in 2019 patients: data from the prospective antifungal therapy alliance registry. Clin Infect Dis 2009;48:1695-703.?
10. Patel GP, Simon D, Scheetz M, Crank CW, Lodise T, Patel N. The effect of time to antifungal therapy on mortality in Candidemia associated septic shock. Am J Ther 2009;16:508-11.?
11. Riedel S, Eisinger SW, Dam L, Stamper PD, Carroll KC. Comparison of BD Bactec Plus Aerobic/F medium to VersaTREK Redox 1 blood culture medium for detection of Candida spp. in seeded blood culture specimens containing therapeutic levels of antifungal agents. J Clin Microbiol 2011;49:1524-9.?
12. Pfaller MA. Antifungal drug resistance: mechanisms, epidemiology, and consequences for treatment. Am J Med 2012;125:S3-13.?
13. Johnson MD, Lewis RE, Dodds Ashley ES, et al. Core recommendations for antifungal stewardship: a statement of the mycoses study group education and research consortium. J Infect Dis. 2020; 222(Suppl 3):S175-S198.?
14. Clancy CJ, Nguyen MH. Finding the "missing 50%" of invasive candidiasis: how nonculture diagnostics will improve understanding of disease spectrum and transform patient care. Clin Infect Dis 2013;56:1284-92.?