Earlier Targeted Therapy Based on T2 Positive

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

Clinical Decision

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).

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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