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.
