Escalation of Appropriate Therapy for P. Aeruginosa

86-year-old patient with a past medical history of ischemic stroke, anemia, diabetes, and hypertension was transferred to the Intensive Care Unit

Discussion

Therapy was escalated to appropriately cover the P. aeruginosa infection in a geographic region endemic for multi-drug resistant P. aeruginosa that was not identified via the blood culture. The patient recovered from the infection and was discharged to a rehabilitation facility.

Presentation

An 86-year-old patient with a past medical history of ischemic stroke, anemia, diabetes, and hypertension was transferred to the Intensive Care Unit due to shock, respiratory distress, fever, and increased WBC. The patient was recovering from a recent hospitalization for a sacral decubitus ulcer and UTI.

Previous Cultures:

Wound Swab: K. pneumoniae and E. faecium

Urine culture from catheter: E. faecalis

Rectal swab: K. pneumoniae

The patient was admitted to the ICU with orders for new blood cultures, urine cultures, T2Bacteria Panel, and was started on empiric antibiotics, IV fluids, and vasopressors.

Patient Selection Criteria

A patient suspected of sepsis with other microbiological evidence of infection

Evaluation and Treatment Decision

Diagnosis: Septic Shock (unknown origin of infection)

Empiric Therapy: Ampicillin/sulbactam and tedizolid

T2Bacteria Result: Positive for P. aeruginosa   

Blood Culture Result: no growth

Decision making based on T2Bacteria Result

A rapid T2Bacteria result allowed for the identification of the P. aeruginosa bacteremia in a patient with septic shock and blood culture-negative infection. This result prompted the prescriber to escalate therapy to ceftolozane/tazobactam and amikacin.   

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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