The patient presented to the emergency department 5 days after appendectomy

Discussion

This case highlights the benefit of the T2Bacteria Panel’s rapid bacterial species identification in a scenario where a patient has already received several days of empiric therapy without significant clinical improvement. Once the causative organism was identified and effective therapy was initiated, the patient experienced rapid clinical improvement. This improvement enabled the patient to be discharged 2 days after the T2Bacteria result, potentially resulting in a reduced length of stay.

Presentation

A 33-year-old patient presented to the emergency department 5 days after appendectomy. The surgery and post-operative course progressed normally until Day 4, when the patient experienced new symptoms, including abdominal pain, fever, and nausea. At the time of assessment in the emergency department, the patient reported sharp pain on the ride side along with moderate areas of redness surrounding the incisions. The patient was admitted and started on ceftriaxone and metronidazole. Blood cultures were obtained and remained negative. On Day 3, the patient had not improved significantly. T2Bacteria was ordered as well as a CT-guided drainage of a right lower quadrant collection.

Patient Selection Criteria

Patient with intra-abdominal infection not improving on empiric antibiotic therapy

Evaluation and Treatment

Diagnosis

Intra-abdominal infection following an appendectomy

Empiric Therapy

Ceftriaxone and metronidazole

Blood Culture Result

Negative

T2Bacteria Panel Result

P. aeruginosa

Culture of Fluid Collection

P. aeruginosa and clostridium species

Decision Making Based on the T2Bacteria Result

Neither Ceftriaxone nor metronidazole provides coverage for P. aeruginosa, both were discontinued. Piperacillin/tazobactam was initiated to treat P. aeruginosa, as well as to provide anaerobic coverage, including against clostridium species.  The patient showed significant improvement on Day 4 and was released from the hospital on Day 5 with oral antibiotic therapy.

An 86 year old patient was transferred to the treating hospital with signs of septic shock.

Discussion

This case highlights the benefit of T2Bacteria’s rapid bacterial species identification, which allowed for a rapid escalation of antibiotic therapy and discontinuation of unnecessary antibiotics once Pseudomonas aeruginosa was identified.

Presentation

An 86 year old patient was transferred to the treating hospital with signs of septic shock. The patient had a history of multiple hospitalizations over the last three months, with several courses of antibiotics to treat pneumonia, as well as wound and urinary tract infections. On admission, the patient was on ampicillin/sulbactam and tedizolid for the treatment of a recent wound infected with K. pneumonia and E. faecalis.

On admission, the left leg wound appeared acutely infected and the patient had a fever as well as low blood pressure requiring vasopressor support. Additionally, the patient had a low platelet count, potentially caused by tedizolid therapy.

Patient Selection Criteria

New-onset suspected sepsis and elevated SOFA score in a patient with risk factors for infection.

Evaluation and Treatment

Diagnosis

Suspected sepsis

Empiric Therapy

Ampicillin/sulbactam and tedizolid

Blood Culture Result

Negative

T2Bacteria Panel Result

P. aeruginosa

Decision Making Based on the T2Bacteria Result:

Ampicillin/sulbactam and tedizolid do not provide coverage for P. aeruginosa and both were discontinued. Ceftolozane/tazobactam was initiated for the treatment of P. aeruginosa based on the local antibiogram. The patient showed significant improvement on Day 2 and was released from the hospital after receiving aggressive wound care and completing antibiotic therapy.

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.

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

Decision making based on T2Candida Result

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).

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

Decision making based on T2Candida Result

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).

A 55-year-old male presented to the hospital from an outside facility with sepsis secondary to pyelonephritis.

Discussion

This case highlights not only T2Bacteria’s ability of rapid identification but also the capability to detect the causative organism in the presence of antibiotics. The patient, in this case, received a dose of ceftriaxone and azithromycin before the blood cultures and T2Bacteria were drawn. Bloodstream infection was missed by blood culture but was identified with rapid detection provided by the T2Bacteria Panel. The use of T2Bacteria, in this case, allowed an early confirmation of effective antibiotic therapy.

Presentation

A 55-year-old male presented to the hospital from an outside facility with sepsis secondary to pyelonephritis. Before transfer, the patient received one dose of ceftriaxone and azithromycin. He was subsequently admitted to ICU with septic shock and acute renal failure, which required the initiation of continuous renal replacement therapy. Blood cultures, urine cultures, and T2Bacteria sepsis panel were obtained.

Patient Selection Criteria

Critically ill patients with sepsis/septic shock and/or elevated procalcitonin

Evaluation and Treatment Decision

Diagnosis

Septic shock secondary to pyelonephritis

T2Bacteria Result

Positive for E. coli

Blood Culture Result

No growth

Urine Culture Result

E. Coli

Empiric Therapy

Cefepime

Decision making based on T2Bacteria Result

A rapid T2Bacteria result allowed for early diagnosis of E. coli bacteremia and the confirmation of effective empiric antibiotic therapy. T2Bacteria detected E. coli directly from whole blood approximately 4 hours after the patient presented to the hospital. The positive T2Bacteria result was obtained hours before the blood cultures were even able to be sent to an off-site core lab to be processed, which ultimately did not grow.