Candida test could save lives
A study by a team of clinicians and scientists from Manchester University NHS Foundation Trust and The University of Manchester, published in the latest issue of the Journal of Antimicrobial Chemotherapy, shows how deaths from a serious blood stream infection caused by the yeast Candida can be avoided. The study using a biomarker found in patients’ blood (b-1-3-D-glucan) also shows a reduction in inappropriate prescriptions of expensive antifungal drugs.
Diagnosis of Candida blood stream infection is difficult leading to over-use of lifesaving but expensive anti-fungal drugs. Antifungal stewardship aims to ensure that only patients with fungal infections are given antifungal drugs. Current challenges include limited availability of diagnostic tests, long laboratory turnaround times, lack of antifungal stewardship expertise and insufficient evidence identifying effective stewardship interventions. Severe fungal infections, including sepsis caused by Candida, are increasingly found in patients in intensive care and is associated with a high mortality rate. The best outcomes for patients are seen when antifungal drugs are started early.
The Infectious Diseases and Intensive Care Units in collaboration with the NHS Mycology Reference Centre at Wythenshawe Hospital in Manchester have been developing an antifungal stewardship program over the past 8 years. Key targets of the program are to improve patient outcome while reducing unnecessary use of antifungal drugs by:
- Updating and implementing concise antifungal guidelines based on a European guidance
- Involving and educating clinical champions
- Improving access to timely diagnostic testing
It is possible to save lives and money with the help of fungal diagnostic tests.”
The main difference in the Manchester study was a patient centred approach focused on improving outcomes compared with most antifungal stewardship programs which are dedicated to managing severe fungal infections and reducing the use of expensive antifungal agents.
The standard diagnostic test for sepsis caused by Candida is blood culture but this has a low sensitivity. There is a perception that available biomarker tests may not be useful forcing clinicians to rely on their clinical experience and judgment. This results in an overuse of antifungal drugs in many intensive care units. The Manchester antifungal stewardship program successfully reduced the mortality due to Candida infection by 58%. At the same time the number of inappropriate prescriptions of antifungal drugs by 90%. The paper concludes that testing for a blood biomarker (β-1-3-D-glucan) allows safe stopping of antifungal drugs in patients in intensive care units at risk of serious fungal infection.
Doctor Riina Rautemaa-Richardson, clinical senior lecturer and researcher at the University of Manchester and Consultant at the Manchester University Foundation Trust said: “It is possible to save lives and money with the help of fungal diagnostic tests.”
Doctor Timothy Felton, an Intensive Care Consultant and University of Manchester honorary lecturer, added: “As an intensive care doctor, I often worry if my patient has a severe fungal infection. Using a fungal diagnostic test allows me to start and stop antifungal drugs with more confidence.”