Evaluation of a rapid, fungal detection panel for the identification of candidemia at an academic medical center.

Objectives To assess the utility of the T2Candida Panel across an academic health center and identify potential areas for diagnostic optimization. Methods A retrospective chart review was conducted on patients with a T2Candida Panel and mycolytic/fungal blood culture collected simultaneously during hospitalizations from February 2017 through March 2018. The primary outcome of this study was to determine the sensitivity, specificity, and positive and negative predictive value of the panel compared to myco/f blood culture. Secondary outcomes included Candida species isolated from culture or detected on the panel, source of infection, days-of-therapy (DOT) of antifungals in patients with discordant results, and overall antifungal DOT/1000 patient days. Results A total of 433 paired T2Candida panel and mycolytic/fungal blood cultures were identified. The pre-test likelihood of candidemia was 4.4%. The sensitivity and specificity were 64.7% and 95.6%, respectively. The positive and negative predictive values were 40.7% and 98.5%, respectively. There were 16 patients with T2Candida Panel positive and myco/f blood culture negative results, while 6 patients had T2Candida Panel negative and myco/f blood culture positive results. Overall antifungal DOT/1000 patient days was improved after implementation of the T2Candida panel, however use of micafungin continued to decline after the panel was removed. Conclusion The T2Candida Panel is a highly specific diagnostic tool; however, the sensitivity and positive predictive value may be lower than previously reported when employed in clinical practice. Clinicians should use this panel as an adjunct to blood cultures when making a definitive diagnosis of candidemia.