Detecting Infections Rapidly and Easily for Candidemia Trial, Part 2 (DIRECT2): A Prospective, Multicenter Study of the T2Candida Panel
Abstract
Background: Blood cultures are approximately 50% sensitive for diagnosing invasive candidiasis. The T2Candida nanodiagnostic panel uses T2 magnetic resonance and a dedicated instrument to detect Candida directly within whole blood samples. Methods: Patients with Candida albicans, Candida glabrata, Candida parapsilosis, Candida tropicalis, or Candida krusei candidemia were identified at 14 centers using diagnostic blood cultures (dBCs). Follow-up blood samples were collected concurrently for testing by T2Candida and companion cultures (cBCs). T2Candida results are reported qualitatively for C. albicans/C. tropicalis, C. glabrata/C. krusei, and C. parapsilosis. T2Candida and cBCs were positive if they detected a species present in the dBC. Results: Median time between collection of dBC and T2Candida/cBC samples in 152 patients was 55.5 hours (range, 16.4-148.4). T2Candida and cBCs were positive in 45% (69/152) and 24% (36/152) of patients, respectively (P < .0001). T2Candida clinical sensitivity was 89%, as positive results were obtained in 32/36 patients with positive cBCs. Combined test results were both positive (T2+/cBC+), 21% (32/152); T2+/cBC-, 24% (37/152); T2-/cBC+, 3% (4/152); and T2-/cBC-, 52% (79/152). Prior antifungal therapy, neutropenia, and C. albicans candidemia were independently associated with T2Candida positivity and T2+/cBC- results (P values < .05). Conclusions: T2Candida was sensitive for diagnosing candidemia at the time of positive blood cultures. In patients receiving antifungal therapy, T2Candida identified bloodstream infections that were missed by cBCs. T2Candida may improve care by shortening times to Candida detection and species identification compared to blood cultures, retaining sensitivity during antifungal therapy and rendering active candidemia unlikely if results are negative. Clinical Trials Registration: NCT01525095.
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Patients who had received antifungal treatment were more likely to have negative blood cultures and positive T2Candida results.
“Patients who had received antifungal treatment were more likely to have negative blood cultures and positive T2Candida results.”
From Treatment of Invasive Candidiasis: A Narrative Review (2018) · cites this paper as [83]
In a multicenter study of patients with candidemia, the sensitivity of T2Candida was double that of conventional blood cultures when both were tested on follow-up blood samples.
“In a multicenter study of patients with candidemia, the sensitivity of T2Candida was double that of conventional blood cultures when both were tested on follow-up blood samples [83].”
From Treatment of Invasive Candidiasis: A Narrative Review (2018) · cites this paper as [83]
T2Candida represents an important advance as the first commercially available, fully-automated rapid assay that specifically detects Candida species.
“T2Candida represents an important advance as the first commercially available, fully-automated rapid assay that specifically detects Candida species.”
From Treatment of Invasive Candidiasis: A Narrative Review (2018) · cites this paper as [83]
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- Authors
- Clancy, C. J., Pappas, P. G., Vazquez, J., Judson, M. A., Kontoyiannis, D. P., Thompson, G. R., Garey, K. W., Reboli, A., Greenberg, R. N., Apewokin, S., Lyon, G. M., Ostrosky-Zeichner, L., Wu, A. H. B., Tobin, E., Nguyen, M. H., & Caliendo, A. M.
- Affiliations
- University of Pittsburgh Medical Center (US)
- University of Alabama at Birmingham Hospital (US)
- Medical College of Georgia, Augusta University, New York
- Albany Medical College (US)
- The University of Texas MD Anderson Cancer Center (US)
- University of California Davis Medical Center (US)
- University of Houston (US)
- Cooper Medical School of Rowan University (US)
- University of Kentucky (US)
- University of Arkansas Medical Center (US)
- Emory Healthcare (US)
- University of Texas Health Science Center, Houston
- University of California, San Francisco (US)
- St Peter's Hospital (US)
- Brown University (US)
- Corresponding author
- Clancy, Cornelius J
- ORCID
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-02-09
- Volume
- 66
- Issue
- 11
- Pages
- 1678-1686
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- OpenAlex
- W2792762681
- Cited by
- 165
- References
- 39
- Citations by year
- 2026: 8 · 2025: 10 · 2024: 15 · 2023: 18 · 2022: 13 · 2021: 26 · 2020: 27 · 2019: 31 · 2018: 17
- FWCI
- 15.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
- Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
- Keywords
- candidemia, invasive candidiasis, Candida species identification, blood culture sensitivity, antifungal therapy, neutropenia, Candida albicans, Candida tropicalis, Candida glabrata, Candida parapsilosis, Candida krusei, rapid fungal detection, diagnostic sensitivity
- MeSH terms
- Candida, Female, Humans, Male, Middle Aged, Magnetic Resonance Spectroscopy, Prospective Studies, Sensitivity and Specificity, Serologic Tests, Candidemia
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