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Faster Time to Targeted Therapy with T2Bacteria

In both of these clinical case studies, T2Bacteria® identified the causative pathogen days sooner than blood culture and allowed for the earlier initiation of targeted therapy.1

Butler Health System | Butler, PA

Case 1
Age and Sex: 70-year-old male

Presentation: The patient presented with shortness of breath, hypothermia, hypertension and was admitted. The patient had no sepsis indicators and no action was taken for sepsis screening.

Vitals: T = 99.8; BP = 152/86; P = 70

Evaluation and Treatment

Day 0

• WBC = 23.2, MDW* = 23.05 lactic acid = 1.0,PCT = .32

• T2Bacteria Result: The T2Bacteria Panel was positive for Enterococcus faecium, and the patient was initiated on targeted therapy

Day 1

• Blood culture confirmed Enterococcus faecium.

T2Bacteria allowed for targeted therapy 20 hours faster than blood culture alone.

Case 2
Age and Sex: 67-year-old male

Presentation: The patient presented with altered mental status and hypotension, and was admitted. The patient had no sepsis indicators and no action was taken for sepsis screening.

Vitals: T not taken, BP= 62/44, P = 53

Evaluation and Treatment

Day 0

• WBC = 24.7, MDW* = 23.98, lactic acid = 1.0, PCT = 4.25

Day 1

T2Bacteria Result: The T2Bacteria Panel was positive for Pseudomonas aeruginosa, and the patient was initiated on targeted therapy

Day 3

• Blood culture confirmed Pseudomonas aeruginosa.

T2Bacteria allowed for targeted therapy 37 hours faster than blood culture alone.

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*This institution uses an algorithm combining Monocyte Distribution Width (MDW) from Beckman Coulter and white blood count (WBC) metrics as an indicator to run T2Bacteria.

  1. Patterson, R., Katsaros, S., Industry Showcase, ASM 2023

PRESIDIO HOSPITAL  |  Caltanissetta, Italy1

A T2Bacteria result facilitated the diagnosis of infective endocarditis that led to the rapid initiation of targeted antibiotic therapy in a critically ill patient with prosthetic valve endocarditis. Fast species ID enabled targeted treatment 8 days before blood culture results were available.

Patient Presentation

The patient was admitted with fever, asthenia, myalgia, and a history of aortic valve replacement and diabetes. On the third day the patient had decompensation with hyperglycemia, hypokalemia, anuria, and hypotension refractory to fluids and vasopressors.

Evaluation and Treatment Decision

Day 3 
Complete system evaluation including chest X-ray, transthoracic echocardiogram, cultures (BAL, blood), T2Bacteria ordered, and broad-spectrum antibiotics administered (ciprofloxacin, daptomycin, linezolid)

WBC 15.2 103/uL, PCT 35.2 ug/L, T2Bacteria test positive for Staphylococcus aureus, positive Osler and Janeway lesions

Antibiotic therapy changed (vancomycin, rifampin, gentamicin) for suspected Staphylococcus aureus prosthetic valve endocarditis.

Day 6
Transthoracic echocardiogram positive for mobile vegetations

Day 11
Anaerobic blood culture positive for Staphylococcus aureus

1. Federico, A., Sicily Medical Education Forum. 2022 

T2Bacteria enabled the detection of polymicrobial infection and the detection of a subsequent Enterococcus faecium infection in a patient where cultures remained negative. Rapid species identification led to targeted therapy and eventual discharge.

Klinik Favoriten | Vienna, Austria

Patient History

Age and Sex: 53-year-old male
History: The patient had no history of chronic diseases
Presentation: The patient was admitted to the hospital with COVID-19 and respiratory failure and was mechanically ventilated
Risk Factors: The patient had multiple risk factors for infection.

  • Presence in ICU
  • Broad spectrum antimicrobial therapy
  • Mechanical ventilation

Evaluation and Treatment

Initial presentation
The patient was admitted to the hospital eight days after the onset of symptoms and then admitted to the ICU with COVID-19 and respiratory failure. The patient was mechanically ventilated.

Weaning was complicated due to ventilator-associated pneumonia.

T2Bacteria Result
The T2Bacteria Panel was positive for Staphylococcus aureus and Escherichia coli, and targeted therapy was initiated before culture results were returned.

Culture Result
A bronchoalveolar lavage sample was also positive for Staphylococcus aureus and Escherichia coli.

Patient Deterioration
10 days later, the patient developed septic shock from an unknown source. Several blood, bronchoalveolar, and urine cultures were taken, but no growth occurred.

Another T2Bacteria Panel was run and was positive for Enterococcus faecium, leading to targeted therapy. A transesophageal echocardiogram revealed endocarditis of the native aortic valve.

Day 42
After 42 days in the ICU, the patient was discharged to a rehabilitation facility.

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T2Candida enabled the detection of candidemia 29 hours before a positive blood culture was returned. Early detection allowed for the rapid initiation of antifungal therapy in a critically ill COVID-19 patient.

Lee Health | Fort Myers, Florida

Patient History

Age and Sex: Elderly Male
History: Patient was admitted to the hospital with confirmed COVID-19. His past medical history included Type 2 diabetes mellitus and hypertension
Presentation: The patient required oxygen support via nasal cannula. A chest radiograph showed bibasilar infiltrates and initial blood cultures were negative.
Risk Factors: The patient had multiple risk factors for candidemia during hospitalization.

  • Presence in ICU
  • Broad-spectrum antimicrobial therapy
  • Immunosupressing medications

Evaluation and Treatment

Day 1
The patient was initiated on azithromycin and methylprednisolone, was given one dose of convalescent plasma

Day 2
Patient was administered 1 dose of tocilizumab (8mg/kg)

Day 3
Patient was intubated for worsening respiratory status

Day 14
Patient developed new fever, chest x-ray showed increased opacities, broad-spectrum antimicrobial therapy was initiated for suspected bacterial pneumonia

Day 15 & 16
Fever escalates (Tmax 101.9F and 103F, respectively). Additional blood cultures were obtained and T2Candida was ordered. T2Candida was positive for Candida albicans/Candida tropicalis 29 hours before the positive blood culture. On the evening of day 16 anidulafungin was initiated

Day 18
Patient defervesced

Day 30
Patient was discharged to a long-term acute care center

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  1. Cubillos, A., et al. CAP, 2021

A 20-year-old patient with a history of lupus presented to the emergency department with shortness of breath.

Discussion

This case highlights the benefit of T2Bacteria’s rapid bacterial species identification, which enabled early identification of the causative pathogen in a critically ill, immunocompromised patient. Bacterial infections commonly occur following the successful treatment of viral infections.  These infections are often missed due to prior antimicrobial use, especially in at-risk patient populations, leading to treatment delays and negative clinical outcomes.

Presentation

A 20-year-old patient with a history of lupus presented to the emergency department with shortness of breath. They had recently recovered from influenza and were otherwise asymptomatic. The patient did not have a previous history of infections, but due to severe shortness of breath of uncertain etiology, was admitted. The patient’s condition worsened, leading to intubation and transfer to the intensive care unit overnight.

Evaluation and Treatment Decision

Day 1: The patient was started on ceftriaxone and azithromycin to cover for possible pneumonia due to rapid deterioration upon admission to the ICU.
Day 2: Due to the lack of clinical improvement,  the intensivist ordered a T2Bacteria Panel and blood cultures, as well as respiratory cultures.

T2Bacteria Result

Positive for P. aeruginosa

Blood Culture

Negative

Respiratory Culture

Positive for P. aeruginosa (36 hours after T2Bacteria result)

Hospital Course and Decision Making Based on the T2Bacteria Result

Based on the T2Bacteria result, the patient was started on meropenem to cover P. aeruginosa and the ceftriaxone was discontinued. The patient began to improve on Day 3 and continued to improve slowly over the remainder of the week. The patient was discharged on Day 7 in stable condition.

A 67-year-old patient had experienced infections, including multi-drug resistant pneumonia, sepsis, and C. difficile colitis during admission.

Discussion

This case highlights the benefit of T2Candida’s rapid fungal species identification, which allowed for the continuation of appropriate antifungal therapy as well as the discontinuation of unnecessary broad-spectrum antibiotics, resulting in clinical improvement.

Presentation

A 67-year-old patient with a history of ALS and chronic respiratory failure was being managed at a long-term acute care (LTAC) facility for the last five months. The patient had experienced infections, including multi-drug resistant pneumonia, sepsis, and C. difficile colitis during admission.

Evaluation and Treatment Decision

Day 1: An infectious disease (ID) physician was called early morning because the patient was experiencing a new symptom of hypothermia. Multiple cultures were obtained, and the patient was started on empiric antibiotic treatment with IV vancomycin, meropenem, polymyxin B, and anidulafungin.

Day 2: The stewardship team recommended that anidulafungin be changed to fluconazole. The ID physician ordered a T2Candida Panel and continued anidulafungin until the results were available.

T2Candida Result

Positive for C. glabrata/C. kruseii.

Fungal Culture Result

no growth reported

Hospital Course and Decision Making Based on the T2Candida Result

On the third day, based on the T2Candida Panel results that were positive for C. glabrata/C. krusei– anidulafungin was continued. On day 5, meropenem and polymyxin B treatment were discontinued, and on day 6, vancomycin was discontinued.

The patient improved and remained off of systemic antibiotic treatment following this episode of fungal sepsis. The patient was transferred in stable medical condition to a subacute facility.

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

PUBLICATIONS

Over 200 studies published in peer-reviewed journals have featured T2MR in a breadth of applications.