Fever of Unknown Origin

The patient admitted to the hospital with COPD exacerbation and respiratory distress

Discussion

This case highlights how the T2Bacteria Panel can guide treatment by rapidly identifying the causative pathogen in sepsis cases that are missed by blood cultures. Rapid detection of bloodstream infection by T2Bacteria could have allowed for the escalation of effective antibiotic therapy, potentially leading to the prevention of further clinical deterioration.

Presentation

The patient admitted to the hospital with COPD exacerbation and respiratory distress. They were subsequently transferred to the ICU with respiratory failure requiring intubation and renal failure. Antibiotics were initiated at the time of admission, but no cultures were obtained. The patient continued to have fever and leukocytosis and on day 5 of hospitalization, blood cultures and T2Bacteria Panel were obtained.

Patient Selection Criteria

Patients with sepsis presenting to ICU from the Emergency Department

Evaluation and Treatment Decision

Diagnosis: fever of unknown origin, possible bloodstream infection

T2Bacteria Result: Positive for P. aeruginosa

Blood culture Result: no growth

Empiric Therapy: Ceftriaxone

Decision making based on T2Bacteria Result

T2Bacteria and blood cultures were obtained after 5 days of antibiotic therapy for an infectious workup for persistent leukocytosis and fever of unknown origin. Because this case was part of an observational study, T2Bacteria results were not reported.  Had T2Bacteria been performed and results reported immediately after collection, it may have prompted the physician to add targeted therapy and avoid clinical deterioration.

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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