Early ID of S. aureus Endocarditis Using T2Bacteria

54-year-old male, with a past medical history of Hepatitis C, presented to the emergency department

Discussion

This case highlights the benefit of the T2Bacteria Panel’s rapid bacterial species identification. Using T2Bacteria allowed for early identification of S. aureus endocarditis in a patient with a limited medical history that had been transferred from an outside hospital. Based on the T2Bacteria results, unnecessary antibiotics were discontinued on Day 1, and the patient received cardiology and infectious disease consultations for the management of endocarditis. The patient’s follow-on blood cultures were negative, likely due to the presence of antibiotics, but the S. aureus bacteremia was confirmed from a blood culture draw obtained prior to admission.

Presentation

A 54-year-old male, with a past medical history of Hepatitis C, presented to the emergency department as a transfer from an outlying hospital. He had septic shock and was directly admitted to the ICU for management.

Evaluation and Treatment Decision

Antibiotics on admission: oxacillin, cefepime, and daptomycin.

Vitals: Temp- 39C, HR- 100BPM

Available labs: WBC- 11.1K CRP- 11.6 mg/dl, PCT – 0.8ng/mL, lactate 1.9 mmol/L

Blood cultures and T2Bacteria were both obtained at admission after initial antibiotic administration: Positive for S. aureus and negative for all other bacterial targets. (T2Bacteria result available at 3h 30min)

Transesophageal echocardiography: Positive for endocarditis

Follow-on Blood Culture Results: no growth

Clinical Decision

The patient’s therapy was adjusted based on the T2Bacteria result. An echocardiogram was ordered, resulting in positive for endocarditis. Oxacillin and cefepime were discontinued, and daptomycin was continued. Blood culture results from the outside hospital were also positive for S. aureus (results received on Day 2).

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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