News

52-year-old male, currently undergoing hemodialysis three times weekly with a complicated medical history.

Discussion

This case highlights the benefit of the T2Bacteria Panel’s rapid species identification, allowing for the rapid initiation of appropriate antimicrobial therapy and resulting in clinical improvement.

Presentation

The patient was a 52-year-old male, currently undergoing hemodialysis three times weekly with a complicated medical history, including diabetes, hypertension, lung cancer, chronic kidney disease. While at dialysis, he experienced confusion and hypotension. The physician was notified, and the patient was transferred to the emergency department. In the emergency department, he was believed to be dehydrated secondary to too much fluid removed during dialysis. He received fluid resuscitation, and blood cultures, and T2Bacteria were obtained. Empiric antibiotics were not initiated.

Evaluation and Treatment Decision

Vitals

Temp- 37.5, HR- 89BPM, BP- 90/60

T2 Result

Positive for E.coli.  Negative for all other bacterial targets. (results available at 6 hours after initial presentation)

Blood Culture Result

no growth reported

Decision making based on T2Candida Result

The patient’s therapy was adjusted based on the T2Bacteria result. The patient did not improve after fluid resuscitation and was being transferred to the ICU at the time of T2Bacteria result due to persistent hypotension. Orders were initially written for vancomycin and cefepime, but the T2Bacteria results were received prior to administration, and therapy was changed to ceftriaxone (targeted therapy for E.coli infection).

A 55-year-old male presented to the hospital from an outside facility with sepsis secondary to pyelonephritis.

Discussion

This case highlights not only T2Bacteria’s ability of rapid identification but also the capability to detect the causative organism in the presence of antibiotics. The patient, in this case, received a dose of ceftriaxone and azithromycin before the blood cultures and T2Bacteria were drawn. Bloodstream infection was missed by blood culture but was identified with rapid detection provided by the T2Bacteria Panel. The use of T2Bacteria, in this case, allowed an early confirmation of effective antibiotic therapy.

Presentation

A 55-year-old male presented to the hospital from an outside facility with sepsis secondary to pyelonephritis. Before transfer, the patient received one dose of ceftriaxone and azithromycin. He was subsequently admitted to ICU with septic shock and acute renal failure, which required the initiation of continuous renal replacement therapy. Blood cultures, urine cultures, and T2Bacteria sepsis panel were obtained.

Patient Selection Criteria

Critically ill patients with sepsis/septic shock and/or elevated procalcitonin

Evaluation and Treatment Decision

Diagnosis

Septic shock secondary to pyelonephritis

T2Bacteria Result

Positive for E. coli

Blood Culture Result

No growth

Urine Culture Result

E. Coli

Empiric Therapy

Cefepime

Decision making based on T2Bacteria Result

A rapid T2Bacteria result allowed for early diagnosis of E. coli bacteremia and the confirmation of effective empiric antibiotic therapy. T2Bacteria detected E. coli directly from whole blood approximately 4 hours after the patient presented to the hospital. The positive T2Bacteria result was obtained hours before the blood cultures were even able to be sent to an off-site core lab to be processed, which ultimately did not grow.

An 81-year-old patient with a complicated medical history was admitted to the hospital for a tracheoesophageal fistula repair.

Discussion

This case highlights the benefit of the T2Bacteria Panel’s turnaround time for species identification. Tigecycline has been associated with high rates of gastrointestinal adverse events such as nausea and vomiting and does not provide adequate coverage of P. aeruginosa. The rapid result provided by T2Bacteria allowed for discontinuation of Tigecycline after only one dose. Additionally, amikacin was added as an antimicrobial known to be effective against P. aeruginosa based on the institution’s antibiogram.

Presentation

An 81-year-old patient with a complicated medical history including diabetes, dysphagia, Parkinson’s Disease, and a history of multiple hospitalizations over the last six months was admitted to the hospital for a tracheoesophageal fistula repair. The patient developed signs and symptoms of pneumonia several days post-operatively. T2Bacteria, blood, sputum, and tracheostomy cultures were obtained after the patient was started on ceftolozane/tazobactam and tigecycline empirically.

Evaluation and Treatment Decision

Vitals

Temp- 36.5, HR- 69BPM

Available labs

WBC- 21.7K CRP- 22.2 mg/dl, PCT – 2.48ng/mL.

T2Bacteria Result

Positive for P. aeruginosa and negative for all other bacterial targets (results available at 5h2min)

Blood Culture Result

no growth reported

Other cultures

Tracheostomy Exit Site: P. aeruginosa, C. albicans; Rectal swab: E. faecium, P. aeruginosa

Decision Making Based on T2Bacteria Results

The patient’s therapy was adjusted based on the T2Bacteria Panel result. Tigecycline was discontinued and the patient was started on amikacin in addition to ceftolozane/tazobactam in order to provide effective coverage for P. aeruginosa.

The patient presented to the emergency department with flu-like symptoms

Discussion

This case highlights the ability of the T2Bacteria® Panel to provide rapid species identification of causative pathogens in sepsis cases. It examines clinical challenges with current methods, including delayed blood culture growth, as well as polymicrobial infections. A rapid T2Bacteria result could have allowed for more informed treatment decisions, including earlier initiation of antibiotic therapy and earlier admission to the hospital.

Presentation

The patient presented to the emergency department with flu-like symptoms, but at the time, clinical status and workup did not warrant admission. The patient continued to decline and re-presented to the emergency department approximately 18 hours later with shortness of breath. While in the emergency department during the second visit, the blood cultures that were obtained during the earlier visit resulted positive with gram-negative rods, and the prescriber was notified. The patient was subsequently admitted, and empiric antibiotics were initiated.

Patient Selection Criteria

Procalcitonin 10.21

Evaluation and Treatment Decision

Diagnosis

bacteremia

T2Bacteria Result

(sample obtained during initial ED visit): Positive for Pseudomonas aeruginosa and E. coli

Blood culture #1 Result

(obtained during initial ED visit): Pseudomonas aeruginosa and Serratia marcescens
(time to culture positivity: 20.5 hours; time to species ID: ~2.5 days for P. aeruginosa and ~5 days for S. marcescens).

*Note: Verigene assay was performed after detection of the growth of gram-negative rod on the culture. It was positive for the detection of Klebsiella oxytoca only and not the pathogens that grew in blood culture.

Blood culture #2 Result

(obtained during second ED visit): E. coli
(time to culture positivity: 24 hours; time to species ID: ~1.5 days)

Empiric Therapy

meropenem

Decision making based on T2Bacteria Result

Note: T2Bacteria results were not reported as this case was part of an observational study.

The blood cultures that were obtained from the patient upon initial presentation had delayed the growth of gram-negative rods, which were found 22 hours later. The patient was discharged from the emergency department prior to blood culture resulting in positive for growth. The patient continued to decline and re-presented to the emergency room, requiring subsequent admission to the hospital.

Had the T2Bacteria test been performed, and the result been reported immediately after collection, the patient could have potentially avoided the premature discharge from the emergency department and earlier initiation of effective antibiotic therapy.

The patient was admitted to the hospital with COPD exacerbation and respiratory distress.

Discussion

This case highlights how the T2Bacteria Panel can guide treatment by rapidly identifying the causative pathogen in sepsis cases that are missed by blood cultures. Rapid detection of bloodstream infection by T2Bacteria could have allowed for the escalation of effective antibiotic therapy, potentially leading to the prevention of further clinical deterioration.

Presentation

The patient was admitted to the hospital with COPD exacerbation and respiratory distress. They were subsequently transferred to the ICU with respiratory failure requiring intubation and renal failure. Antibiotics were initiated at the time of admission, but no cultures were obtained. The patient continued to have fever and leukocytosis and on day 5 of hospitalization, blood cultures and T2Bacteria Panel were obtained.

Patient Selection Criteria

Patients with sepsis presenting to ICU from the Emergency Department

Evaluation and Treatment Decision

Diagnosis

fever of unknown origin, possible bloodstream infection

T2Bacteria Result

Positive for P. aeruginosa

Blood culture Result

no growth

Empiric Therapy

Ceftriaxone

Decision making based on T2Bacteria Result

T2Bacteria and blood cultures were obtained after 5 days of antibiotic therapy for an infectious workup for persistent leukocytosis and fever of unknown origin. Because this case was part of an observational study, T2Bacteria results were not reported.  Had T2Bacteria been performed and results reported immediately after collection, it may have prompted the physician to add targeted therapy and avoid clinical deterioration.

The patient presented to the Emergency Department with acute respiratory failure and was admitted to the ICU with orders for blood cultures, T2Bacteria, and empiric antibiotics.

Discussion

In this case, rapid detection of bloodstream infection by the T2Bacteria Panel could have allowed for more informed treatment decisions, including the continuation of effective antibiotic therapy, which may have led to the prevention of clinical deterioration.

Presentation

The patient presented to the Emergency Department with acute respiratory failure and was admitted to the ICU with orders for blood cultures, T2Bacteria, and empiric antibiotics.

Patient Selection Criteria

Patients with sepsis presenting to ICU from the Emergency Department

Evaluation and Treatment Decision

Diagnosis

Possible pneumonia

T2Bacteria Result

Positive for P. aeruginosa

Blood culture Result

No growth

Respiratory Culture #1 Result

Enterobacter (resistant to cefepime, susceptible to levofloxacin)

Respiratory Culture #2 Result

P. aeuriginosa (intermediate resistance to levofloxacin, susceptible to cefepime and imipenem)

Empiric Therapy

cefepime, vancomycin

Decision making based on T2Bacteria Result

T2Bacteria and blood cultures were obtained for an infectious workup at the time of admission (T2Bacteria results were not reported, as this case was part of an observational study).

Empiric antibiotics included cefepime and vancomycin. Antibiotic therapy was changed to levofloxacin on day 5 of hospitalization to target the Enterobacter species, which was identified in the first respiratory culture. The patient continued to decline, and a second respiratory culture was obtained on day 10 of hospitalization, which grew P. aeuriginosa with intermediate resistance to levofloxacin. Antibiotics were then escalated to meropenem to treat both respiratory pathogens that were isolated in cultures.

Had the institution known of the rapid T2Bacteria result of P. aeuriginosa, the physician may not have changed therapy to levofloxacin considering the patient’s risk factors and local resistance patterns. Clinical deterioration could potentially have been avoided.

A 45-year-old male presented to an acute care hospital with a perforated small bowel.

Discussion

This case highlights the benefit of T2Candida’s rapid fungal species identification. These results allowed for a prompt escalation of antifungal therapy once a species with a high prevalence of resistance was identified. Additionally, unnecessary antibiotics were discontinued.

Presentation

A 45-year-old male presented to an acute care hospital with a perforated small bowel. He developed septic shock requiring intubation and was effectively treated with broad-spectrum antibiotics. He became hemodialysis-dependent following this episode.  Eventually, a tracheotomy was performed, he was initiated on TPN, and transferred to a long-term acute care (LTAC) hospital.

On admission to the LTAC, he was stable, and a draining fistula was noted. On Day 3 of LTAC admission, the patient developed new fevers and leukocytosis.

Patient Selection Criteria

New-onset suspected sepsis in a patient with risk factors for candidemia

Evaluation and Treatment

Diagnosis

Suspected sepsis and intra-abdominal infection

Empiric Therapy

Vancomycin, Meropenem, and Fluconazole initiated

Blood Culture Result

Negative

T2Candida Panel Result

C. parapsilosis

Decision making based on the T2Candida Result

The nurse and pharmacy were given the results of the T2Candida test. They alerted the infectious diseases pharmacist who, in turn, called the infectious diseases physician. The infectious diseases physician stopped the vancomycin and meropenem.  Antibiogram data from this institution showed greater than 50%  fluconazole resistance in C.parapsilosis blood isolates, so fluconazole was changed to micafungin for a 14-day course.

 

Discussion

In this case, rapid detection of bloodstream infection by the T2Bacteria Panel could have allowed for more informed treatment decisions, including early initiation of effective antibiotic therapy, potentially leading to prevention of clinical deterioration and avoidance of readmission.

Presentation

64-year-old patient admitted with liver failure, hepatic encephalopathy, and respiratory failure requiring intubation. Blood cultures were ordered as part of an infectious workup, but were negative and no antibiotics were administered. The patient was discharged after 9 days of hospitalization then re-presented the following day with hypotension and acute respiratory failure requiring intubation.

Patient Selection Criteria

Patients with sepsis presenting to ICU from the Emergency Department

Evaluation and Treatment Decision

Diagnosis

Sepsis secondary to UTI

T2Bacteria Panel Result

(obtained during initial admission with blood cultures as part of an observational study) Positive for S. aureus

Blood Culture Result 

(obtained during initial admission) S. vestibularis (1/2 bottles)

Second Blood Culture Result

(obtained during re-admission) No growth

Urine Culture Result 

(obtained during re-admission) S. aureus

Nasal PCR

(obtained during re-admission): Positive for MRSA

Empiric Therapy

(initiated during re-admission) Ceftriaxone; vancomycin added on day 3 of re-admission following urine culture results and clinical deterioration of the patient

Decision making based on T2Bacteria Panel Result

T2Bacteria and blood cultures were obtained for infectious workup during the patient’s initial admission. T2Bacteria sepsis test results were not reported as this case was part of an observational study. Antibiotics were not administered and the patient was discharged after a nine-day hospitalization. Less than 24 hours later, the patient was re-admitted with acute respiratory failure and sepsis secondary to suspected UTI and was found to have S. aureus in urine and nasal PCR positive for MRSA. If the T2Bacteria Panel had been performed and the result reported immediately after collection, it could have prompted the physician to target therapy 11 days sooner and potentially avoid readmission.

57-year-old male transferred to long-term acute care (LTAC) facility for long-term ventilatory support and rehabilitation.

Discussion

This case highlights how the high negative predictive value (NPV) of the T2Candida Panel enables the ability to rule out the five most common Candida species in a clinical setting. In this case, because of the rapid negative result, antifungal therapy could be de-escalated early in the patient’s course.

Presentation

57-year-old male transferred to long-term acute care (LTAC) facility for long-term ventilatory support and rehabilitation. On Day 6 of admission to LTAC, the patient spiked a fever of 100.9 F with increased oxygen requirements and drainage from enterocutaneous fistula. The patient has a history of penetrating abdominal trauma, tracheostomy, and multiple re-explorations/evacuations of intra-abdominal abscesses, partial gastrectomy, and placement of abdominal wound VACs.

Patient Selection Criteria

Multiple abdominal surgeries, empiric use of micafungin

Evaluation and Treatment

Diagnosis

Sepsis from intra-abdominal infection and/or possible pneumonia

Empiric Therapy

The patient was switched from ceftriaxone to imipenem/cilastatin, vancomycin, and micafungin for suspected abdominal sepsis and possible pneumonia.

Blood Culture Result

No growth

Tracheal Aspirate Culture Result

No growth

Urine Culture

Vancomycin-resistant Enterococcus faecium

T2Candida Panel Result

Negative for the five target pathogens

Decision making based on the T2Candida Result

T2Candida was negative, therefore micafungin was discontinued after only a single dose.

Blood and sputum cultures demonstrated ‘no growth’ after 48 hours. Urine culture was positive for VRE, so vancomycin was switch to linezolid on day 3 of antimicrobial therapy. The patient completed a course of antibacterials x 10 days total.

A patient suffering from status epilepticus and traumatic brain injury was admitted to the ICU

Discussion

In the case presented, the T2Bacteria result enabled clinicians to initiate appropriate antibiotic therapy within three hours from the diagnosis of septic shock and helped to avoid the unnecessary Gram-positive antibiotic coverage while targeting therapy to cover for P. aeruginosa.

Presentation

A 36-year-old male patient suffering from status epilepticus and traumatic brain injury was intubated and admitted to the Intensive Care Unit (ICU). During his ICU stay the patient became febrile and a diagnosis of intubation-associated sinusitis was made. Prior respiratory cultures revealed Klebsiella pneumoniae (KPC-producing) and the patient was started on ceftazidime-avibactam. Over the next 24 hours, the patient deteriorated clinically and fulfilled the criteria of septic shock requiring fluid resuscitation and initiation of vasopressors. The attending physicians obtained new blood cultures and added empiric Gram-positive antibiotic coverage. A T2Bacteria test was also ordered.

Patient Selection Criteria

Critical care patient with septic shock and bloodstream infection suspected.

Evaluation and Treatment Decision

Diagnosis

Septic shock

Empiric Therapy

The patient was on ceftazidime-avibactam at the time of septic shock. This antibiotic selection was based on previous microbiology results (respiratory fluid culture).

T2Bacteria Result

P. aeruginosa

Blood Culture Result

P. aeruginosa (returned 72 hours after T2Bacteria positive result)

Decision making based on T2Bacteria Result

A rapid T2Bacteria result allowed for the timely identification of the P. aeruginosa bacteremia in a patient that was receiving therapy for multidrug-resistant K. pneumoniae infection. This finding prompted the escalation of therapy with the addition of colistin to cover for the P. aeruginosa infection according to local antibiotic resistance patterns and breakthrough infection while on ceftazidime-avibactam. Gram-positive coverage was discontinued and the blood culture result came back positive for P. aeruginosa 72 hours later.

 

A 68-year-old male with fevers, lethargy, and anorexia was admitted.

Discussion

This case highlights not only the benefit of rapid species identification with the T2Canida Panel but also timely diagnosis of Candida endocarditis that may present as culture-negative endocarditis.  It also illustrates the potential role of T2Candida in monitoring clinical response in a persistently positive Candida endocarditis patient.

Presentation

A 68-year-old male with a past medical history of systolic heart failure with ICD placement, ulcerative colitis status post a colectomy, cirrhosis secondary to primary sclerosing cholangitis underwent a liver transplant. A few months later the patient was admitted with fevers, lethargy, and anorexia.  Routine blood cultures were negative, however, Cytomegalovirus (CMV) levels were positive and IV ganciclovir was initiated.  The patient remained in the hospital for five days and was discharged home.  The patient was readmitted ten days later with fever, fatigue, and a blind spot in the right eye with improving CMV. Blood culture and T2Candida were drawn, and anidulafungin was started. T2Candida was reported positive for C. albicans/C. tropical and ophthalmology obtained intravitreal cultures which were positive for C. albicans. A TTE was obtained and was negative for vegetation.  Blood cultures were pending but negative to date.  ID recommended intravitreal voriconazole injections, fluconazole 800mg daily adjusted for renal function for six months and to continue IV anidulafungin for two weeks and discharged home.  The patient was re-admitted for a 3rd time with fevers up to 104° F, dyspnea, and fatigue.  CMV PCR was negative, blood cultures were drawn, and another T2Candida was obtained. T2Candida remained persistently positive whereas the blood cultures were persistently negative to date. The patient was continued on fluconazole and restarted on anidulafungin.

Pleural and pericardial effusions were identified and no organism was detected via multiple different diagnostic tests.  A TEE was done due to the persistently positive T2Candida and mobile vegetation was identified on the pulmonic valve.  The patient was considered to be too high risk for surgical removal of the vegetation thus an angiovac was done by interventional radiology.  Tissue cultures of the vegetation were obtained and C. albicans and S. hominis grew out.  Repeat ophthalmology evaluation showed retinitis improving.

Patient Selection Criteria

Empiric use of an echinocandin

Evaluation and Treatment

Diagnosis: Candida retinitis and Candida infective endocarditis

Empiric Therapy: The patient was started on anidulafungin

T2Candida Panel Result: Positive for C. albicans/C. tropicalis, negative for the remaining three pathogens.

Blood Culture Result: No growth

Decision making based on the T2Candida Result

A rapid and persistent T2Candida positive for C. albicans/C. tropicalis prompted the team start the patient on anidulafungin and fluconazole due to the source of the infection.  Once Candida retinitis was confirmed it lead to the addition of intravitreal voriconazole.  Due to the persistent T2Candida despite being on adequate therapy, it further prompted clinicians to investigate an alternate source of infection leading to the detection of fungal infective endocarditis. Post removal of the vegetation an additional T2Candida was obtained and was negative.  Once stable the patient was discharged home with IV anidulafungin, fluconazole and vancomycin.

A 58-year-old female with a history of metastatic breast cancer presented to the clinic.

Discussion

This case highlights the ability of the T2Bacteria® Panel to provide rapid species identification and detection of the causative organisms when blood cultures do not, including polymicrobial infections.

This high-risk, immunocompromised patient was initially treated with ceftriaxone and azithromycin for empiric treatment of pneumonia. Rapid species identification prompted an escalation of therapy to the anti-pseudomonal antibiotic, cefepime. The patient defervesced the day after therapy escalation and continued to clinically improve with cefepime continuation until hospital discharge. Without the availability of T2Bacteria, the patient may have remained on inappropriate therapy for days until further clinical deterioration may have led to an empiric switch/broadening of therapy

Presentation

A 58-year-old female with a history of metastatic breast cancer presented to the clinic with shortness of breath, fever, and pancytopenia. She was then admitted to the hospital with orders for blood cultures, T2Bacteria, and empiric antibiotics.

Patient Selection Criteria

The patient was admitted to the hematology-oncology unit with a suspected bloodstream infection

Evaluation and Treatment Decision

Diagnosis

Pneumonia

Empiric Therapy

Ceftriaxone and azithromycin

T2Bacteria Result

Positive for P. aeruginosa and E. coli

Blood Culture Result

No growth

Chest x-ray

Evidence of right lower lobe pneumonia

Decision making based on T2Bacteria Result

A rapid T2Bacteria result allowed for the identification of the P. aeruginosa and E. coli bacteremia in a patient with a culture-negative infection. This prompted the prescriber to escalate therapy to cefepime for the coverage of the P. aeruginosa that was not identified via the blood culture.

Media Contact

Gina Kent
610-455-2763
gkent@vaultcommunications.com

According to the CDC, of the 154 million prescriptions for antibiotics written in doctors’ offices and emergency departments each year, 30% are unnecessary.12

PUBLICATIONS

Over 200 studies published in peer-reviewed journals have featured T2MR in a breadth of applications.