The patient presented to the emergency department 5 days after appendectomy
Discussion
This case highlights the benefit of the T2Bacteria Panel’s rapid bacterial species identification in a scenario where a patient has already received several days of empiric therapy without significant clinical improvement. Once the causative organism was identified and effective therapy was initiated, the patient experienced rapid clinical improvement. This improvement enabled the patient to be discharged 2 days after the T2Bacteria result, potentially resulting in a reduced length of stay.
Presentation
A 33-year-old patient presented to the emergency department 5 days after appendectomy. The surgery and post-operative course progressed normally until Day 4, when the patient experienced new symptoms, including abdominal pain, fever, and nausea. At the time of assessment in the emergency department, the patient reported sharp pain on the ride side along with moderate areas of redness surrounding the incisions. The patient was admitted and started on ceftriaxone and metronidazole. Blood cultures were obtained and remained negative. On Day 3, the patient had not improved significantly. T2Bacteria was ordered as well as a CT-guided drainage of a right lower quadrant collection.
Patient Selection Criteria
Patient with intra-abdominal infection not improving on empiric antibiotic therapy
Evaluation and Treatment
Diagnosis
Intra-abdominal infection following an appendectomy
Empiric Therapy
Ceftriaxone and metronidazole
Blood Culture Result
Negative
T2Bacteria Panel Result
P. aeruginosa
Culture of Fluid Collection
P. aeruginosa and clostridium species
Decision Making Based on the T2Bacteria Result
Neither Ceftriaxone nor metronidazole provides coverage for P. aeruginosa, both were discontinued. Piperacillin/tazobactam was initiated to treat P. aeruginosa, as well as to provide anaerobic coverage, including against clostridium species. The patient showed significant improvement on Day 4 and was released from the hospital on Day 5 with oral antibiotic therapy.
