A rapid T2Bacteria result could have allowed for more informed treatment decisions, including the initiation of earlier effective therapy over 30 hours sooner.
Discussion
Upon admission, the patient was initially given ceftriaxone and azithromycin for the treatment of suspected community-acquired pneumonia. Due to the patient’s history of COPD, he was at risk for organisms such as MRSA (methicillin-resistant Staphylococcus aureus) in addition to the more common causes of community-acquired pneumonia such as Streptococcus pneumoniae and atypical organisms.
At the time of admission, he had blood cultures obtained, and T2Bacteria ordered. At this hospital, patient selection for T2Bacteria testing was based on elevated lactate and/or procalcitonin in patients presenting to the emergency department with suspected bloodstream infections.
Effective therapy against MRSA was not initiated until blood cultures demonstrated the growth of S. aureus over 30 hours after admission (T2Bacteria results were not reported as this case was part of an observational study). Had the T2Bacteria test been performed and result been reported immediately after collection, the patient could have been initiated on effective empiric therapy over 30 hours sooner.
Presentation
A 59-year-old male with a history of rectal cancer and COPD. The patient presented to the emergency department with shortness of breath, cough, fever, and chills. Sepsis was suspected, and the patient was admitted with orders for blood cultures, T2Bacteria, and antibiotics.
Patient Selection Criteria
Lactic acid 2.8 mg/dl
Procalcitonin 59 ng/ml
Evaluation and Treatment Decision
Diagnosis: Community-acquired pneumonia
Empiric Therapy: Ceftriaxone, Azithromycin
Ceftriaxone and azithromycin were chosen for coverage of common causative respiratory pathogens identified in community-acquired pneumonia.
T2Bacteria Result: Positive for S. aureus and negative E. faecium, P. aeruginosa, E. coli, and K. pneumoniae.
Blood Culture Result: Methicillin-resistant Staphylococcus aureus (36-hour delay in species identification from time of blood culture collection)
Decision making based on T2Bacteria Result
A rapid T2Bacteria result could have allowed for more informed treatment decisions, including the initiation of earlier effective therapy over 30 hours sooner.
