Clinical Utility of the T2Candida NPV

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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Critical Care Patient with Septic Shock

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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Candida Retinitis and Candida Infective Endocarditis

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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Suspected Blood Stream Infection

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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Sepsis in an Immunocompromised Patient with a Central Line

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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Septic Shock in an Immunocompromised Hemodialysis Patient

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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Septic Shock with Fever

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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Suspected Acute Cholecystitis

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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T2Bacteria® Negative De-escalation

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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Thrombus in Left Popliteal Artery

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