This case highlights the ability of the T2Bacteria® Panel to provide rapid species identification and detection of the causative organisms when blood cultures do not, including polymicrobial infections.
This high risk, immunocompromised patient was initially treated with ceftriaxone. The rapid T2Bacteria result for pseudomonas allowed for the escalation of therapy to meropenem and amikacin. Additionally, the positive T2Bacteria result prompted the removal of the central line as the suspected source of the infection. The culture from the catheter tip confirmed P. aeruginosa, five days after the initial P. aeruginosa result from T2Bacteria. Rapid species identification allowed for rapid escalation of therapy. Without the availability of T2Bacteria, the patient may have remained on inappropriate therapy for days until further clinical deterioration may have led to an empiric switch/broadening of therapy.
27-year-old male admitted after developing fever and increased white blood cell count during hemodialysis.
This high risk, immunocompromised patient was initially treated with broad-spectrum antimicrobials. When he developed septic shock, micafungin was initiated immediately as candidemia accounts for 3-10% of all septic shock and each hour delay in instituting an active antimicrobial reduces survival in both septic shock and candidemia. Ideally, T2Candida would have been collected prior to giving micafungin. However, testing after antifungal dosing retains value because T2Candida positivity is significantly less likely to be impacted by treatment than are blood culture results.
This case highlights not only the benefit of rapid species identification with the T2Bacteria Panel but also the Panel’s ability to prevent therapy that is not necessary as well as to detect the causative organisms that blood cultures may not due to infection localized within an abscess.
This case highlights not only the benefit of rapid species identification with the T2Bacteria Panel but also the Panel’s ability to detect the causative organisms when blood culture does not.
67-year-old female admitted for reduced intensity conditioning followed by Stem Cell transplant for acute myelogenous leukemia.
Patients undergoing cytotoxic chemotherapy and hematopoietic stem-cell transplantation (HSCT) are at high risk for infection, particularly during the period of neutropenia and are often prescribed antibiotic prophylaxis with fluroquinolones. The majority of patients who develop fever during neutropenia have no identifiable site of infection and no positive culture results. IDSA guidelines recommend that every patient with fever and neutropenia receive empiric antibiotic therapy with an antipseudomonal beta lactam urgently after presentation, because infection may progress rapidly.1
Rapid molecular diagnostics such as T2MR technology may help with prognosis of invasive candidiasis. The T2Candida Panel was utilized upon follow up to assess the clearance of candidemia along with clinical symptoms.
A 23-year-old female with a history of acute myeloid leukemia and recent haploidentical stem cell transplant, cytokine release syndrome and severe mucositis following receipt of post-transplant cyclophosphamide therapy.
Upon admission, the patient was initially given cefepime for the treatment of febrile neutropenia. Due to the patient’s history of AML and neutropenia, she was at risk for organisms such as P. aeruginosa in addition to other common causes of febrile neutropenia such as Enterobacteriaceae.
This case highlights not only T2Bacteria’s benefit of rapid identification but also the ability to detect the causative organism in the presence of antibiotics as this patient had received the dose of vancomycin before the T2Bacteria was drawn.
81 year old female admitted with a one-day history of fever, rigors, weakness, and confusion. Blood and urine cultures were ordered as well as IV antibiotics.
Discussion/Decision Making Based on T2Bacteria Result
At this point in time, the hospital has not adopted T2Bacteria, however, another hospital in their system has. Given the high likelihood that the repeat BCx would be negative, they were asked to draw a blood sample on the day the patient was ready for discharge and send it to the institution that currently utilized the T2Bacteria Panel.