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 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. 

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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.

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An elderly patient presented to the ED with a day-long history of fever, shaking, suprapubic pain, vomiting, and diarrhea

Discussion

This case highlights not only T2Bacteria’s ability of rapid identification but also the capability to detect the causative organism and use the result to de-escalate therapy.

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An elderly patient presented to the ED with nausea, myalgia, and insomnia

Discussion

This case highlights the benefit of the T2Bacteria Panel’s ability to provide species identification in the presence of antimicrobial therapy rapidly.  Using T2Bacteria enabled the identification of E.coli in a patient on inadequate therapy for a urinary tract infection (UTI).

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A patient was admitted with a two-day history of right lower quadrant pain, fever, and vomiting

Discussion

This case highlights the benefit of rapid species identification with the T2Bacteria Panel and the potential prevention of additional sequelae with a premature discharge from the ED.

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A 72 year-old-patient presented to the ER with productive cough for three days, left flank pain, and intermittent nausea

Discussion

This case highlights the benefits of using the high negative predictive value (NPV) of the T2Bacteria Panel for early de-escalation of therapy, mainly when using antimicrobial agents that can commonly cause acute kidney injury.

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A severely dehydrated elderly patient was admitted for septic shock overnight

Discussion

This case highlights not only T2Bacteria’s ability to rapidly identify specific bacterial pathogens in whole blood but also the capability to detect the causative organism in the presence of antibiotics where blood cultures remained negative, as well as an opportunity to use the result to de-escalate therapy.

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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.

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An 86 year old patient 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.

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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.

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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.

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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.

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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.

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An 81-year-old patient with a complicated medical history was admitted to the hospital for a tracheoesophageal fistula repair.

Discussion

This case highlights the benefit of T2Bacteria Panel’s turnaround time for species identification. Tigecycline has been associated with high rates of gastrointestinal adverse events such as nausea and vomiting and does not provide adequate coverage of P. aeruginosa. The rapid result provided by T2Bacteria allowed for discontinuation of Tigecycline after only one dose. Additionally, amikacin was added as an antimicrobial known to be effective against P. aeruginosa based on the institution’s antibiogram.

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The patient presented to the emergency department with flu-like symptoms

Discussion

This case highlights the ability of the T2Bacteria® Panel to provide rapid species identification of causative pathogens in sepsis cases. It examines clinical challenges with current methods, including delayed blood culture growth, as well as polymicrobial infections. A rapid T2Bacteria result could have allowed for more informed treatment decisions, including earlier initiation of antibiotic therapy and earlier admission to the hospital.

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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.

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The patient presented to the Emergency Department with acute respiratory failure and was admitted to the ICU with orders for blood cultures, T2Bacteria, and empiric antibiotics.

Discussion

In this case, rapid detection of bloodstream infection by the T2Bacteria Panel could have allowed for more informed treatment decisions, including the continuation of effective antibiotic therapy, which may have led to the prevention of clinical deterioration.

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A 45-year-old male presented to an acute care hospital with a perforated small bowel

Discussion

This case highlights the benefit of T2Candida’s rapid fungal species identification. These results allowed for a prompt escalation of antifungal therapy once a species with a high prevalence of resistance was identified. Additionally, unnecessary antibiotics were discontinued.

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Discussion

In this case, rapid detection of bloodstream infection by the T2Bacteria Panel could have allowed for more informed treatment decisions, including early initiation of effective antibiotic therapy, potentially leading to prevention of clinical deterioration and avoidance of readmission.

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57 year old male transferred to long-term acute care (LTAC) facility for long-term ventilatory support and rehabilitation

Discussion

This case highlights how the high negative predictive value (NPV) of the T2Candida Panel enables the ability rule out the five most common Candida species in a clinical setting. In this case, because of the rapid negative result, antifungal therapy could be de-escalated early in the patient’s course.

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A patient suffering from status epilepticus and traumatic brain injury was admitted to the ICU

Discussion

In the case presented, the T2Bacteria result enabled clinicians to initiate appropriate antibiotic therapy within three hours from the diagnosis of septic shock and helped to avoid the unnecessary Gram-positive antibiotic coverage while targeting therapy to cover for P. aeruginosa.

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A 68 year old male with fevers, lethargy and anorexia was admitted

Discussion

This case highlights not only the benefit of rapid species identification with the T2Canida Panel but also timely diagnosis of Candida endocarditis that may present as culture-negative endocarditis.  It also illustrates the potential role of T2Candida in monitoring clinical response in a persistently positive Candida endocarditis patient.

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A 58-year-old female with history of metastatic breast cancer presented to clinic.

Discussion

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.

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An immunocompromised patient was admitted after developing fever and rigors.

Discussion

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.  

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27-year-old male admitted after developing fever and increased white blood cell count during hemodialysis.

Discussion

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.

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An 86 year old patient presented with fevers and lethargy for one week.

Discussion

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.

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An 82-year-old patient presented in the emergency department with a fever.

Discussion

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.

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67-year-old female admitted for reduced intensity conditioning followed by Stem Cell transplant for acute myelogenous leukemia.

Discussion

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

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Patient presented with acute onset of pain in his left lower extremity

Discussion

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.

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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.

Discussion:

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.

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Patient had a history of multiple myeloma, prostate cancer and CHF.

Discussion

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.

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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.

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The T2Candida Panel was used to assess for the presence of disease and continuation of antifungal therapy, despite negative blood cultures.

Discussion


Rapid molecular diagnostics such as T2MR technology may help with prognosis of invasive candidiasis. For our case, the T2Candida Panel was utilized upon follow up to assess clearance of candidemia along with clinical symptoms.

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83-year-old male presented to the emergency department with urinary retention.

Had the T2Bacteria test been performed and result been reported immediately after collection, the patient could have been initiated on effective empiric therapy over 24 hours sooner, and P. aeruginosa bacteremia identified over two days earlier.

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Patient presented to the emergency department with shortness of breath, cough, fever and chills.

A rapid T2Bacteria result could have allowed for more informed treatment decisions, including the initiation of earlier effective therapy over 30 hours sooner.

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91-year-old female presented to the emergency department with several day history of fever, chills, and nausea/vomiting.

Had the T2Bacteria® test been performed and result been reported immediately after collection, the patient could have potentially avoided premature discharge and readmission.

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Patient with insulin-dependent diabetes mellitus, primary sclerosing cholangitis, multiple bacteremic episodes and recent liver transplant was admitted.

In this case, T2Candida® results could have permitted earlier focused therapy and aided with the diagnosis of invasive Candida infection and lead to appropriate antifungal therapy. Unfortunately, the T2Direct Diagnostics results were not in clinical use at the time and not obtained until after patient death.

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Patient presents to the Emergency Department from nursing home with fever, dyspnea, and altered mental status.

Discussion

At the time of admission, this patient had blood cultures obtained, and T2Bacteria ordered. At Piedmont Columbus Regional, patient selection for T2Bacteria testing was based on >2 SIRS criteria PLUS suspected source of infection PLUS hypotension or altered mental status. This patient was positive for 2 of 4 SIRS criteria and had a suspected cause of infection and altered mental state, thus meeting criteria for testing.

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Patient presents with suspected sepsis

Discussion

Upon admission, the patient was initially given the broad spectrum antibiotics linezolid, aztreonam, and metronidazole for the treatment of suspected intra-abdominal sepsis. Due to the patient’s recent healthcare exposure, she was at risk for organisms such as MRSA (methicillin-resistant Staphylococcus aureus) and Pseudomonas aeruginosa in addition to the more common causes of intra-abdominal infection such as enterobacteriaceae and anaerobic organisms. 

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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