Critical Results Received without Interference from Empiric Therapy

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.

 

 

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