Candidemia
Fluconazole vs. Echinocandin
|
Optimizing antifungal therapy earlier via rapid identification of Candida species from positive blood cultures
|
“Therapy for 81% of patients with C. glabrata sepsis was changed from fluconazole to caspofungin and 70% of patients with C. albicans fungemia had therapy switched from caspofungin to fluconazole within hours of reporting PNA FISH results.”
Della-Latta et al. Poster # P1382, ECCMID 2008. Barcelona, Spain.
|
|
|
|
The Challenge
|
|
Appropriate Antifungal Selection for Candidemia: Fluconazole or Echinocandin?
Candida species are the fourth most common cause of hospital-acquired bloodstream infections and are associated with the highest mortality rates.(1) Although species identification is highly predictive of likely antifungal susceptibility, conventional laboratory methods can take days, forcing physicians to treat patients empirically with broad-spectrum, antifungal agents.(1) In addition, resistance to fluconazole in certain species such as Candida glabrata and Candida krusei has led to increased use of newer and more expensive echinocandins such as caspofungin, micafungin and anidulafungin. These antifungals may be unnecessary and substantially increase drug costs, or in some cases as with Candida parapsilosis, may be less effective than fluconazole. |
| |
 |
|
Incidence and fluconazole susceptibility of 5 major Candida species.(3)
|
The Dilemma
|
|
Conventional Identification of Candida Species Takes 2-5 days
|
Gram stain - Yeast
|
- Cannot distinguish between Candida species from a Gram stain
- Conventional culture and phenotypic identification can take an additional 2-5 days.
- Clinicians can’t wait 2-5 days to prescribe antifungals for candidemia patients.
|
PNA FISH® Solution
|
|
Rapid Identification and Differentiation of Candida Species
|
Yeast Traffic Light®
|
- 90 min. molecular identification and differentiation of Candida species directly from positive blood cultures.
- Results 2-5 days earlier than conventional methods.
- Proven to help:
- Optimize antifungal drug selection (fluconazole vs. echinocandin) for C. albicans and C. glabrata.(4)
- Shorten time to appropriate antifungal therapy.(5)
- Lower antifungal drug costs.(5,6)
|
Proven Benefits
|
|
Shorten Time to Initiation of Appropriate Antifungal Therapy
Retrospective study of 148 candidemia cases (76 control, 72 PNA FISH) with Yeast-positive blood cultures performed at the University of Maryland Medical Center (Baltimore, MD).(5)
|
 |
|
- Early identification and notification of C. albicans vs. non-C. albicans results
- Improved time to results by 35-52 hours
|
|
|
Improve Antifungal Therapy Selection
Study on the impact of antifungal selection based on PNA FISH results for 45 patients with Yeast-positive blood cultures performed at New York Presbyterian Hospital/Columbia University Medical Center.(4)
|
 |
|
- Early identification and notification of C. albicans and C. glabrata by PNA FISH
- 70% of C. albicans patients receiving empiric caspofungin were switched to fluconazole
- 81% of C. glabrata patients receiving empiric fluconazole were switched to caspofungin
|
|
|
Lower Antifungal Costs
Retrospective analysis of antifungal usage and costs from 2002 to 2007 at the University of Maryland Medical Center.(7)
|
 |
|
- Reduced total echinocandin usage by 3.55 defined daily doses (DDD) per 1,000 patient days
- Reduced annual echinocandin costs by $214,641
- Overall savings of $514,237 over three year period using PNA FISH
|
|
1. IDSA Guidelines. Clin Infect Dis. 2004; 38: 161-189