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Suspected Urinary Tract Infection

A 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 the result been reported immediately after collection, the patient could have potentially avoided premature discharge and readmission.  
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. Patient with insulin-dependent diabetes mellitus, primary sclerosing cholangitis, multiple bacteremic episodes, and recent liver transplant was admitted.
The patient presents to the Emergency Department from a nursing home with a 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 the criteria for testing.
The patient presents with suspected sepsis.

Discussion

Upon admission, the patient was initially given a 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. 
According to the CDC, of the 154 million prescriptions for antibiotics written in doctors’ offices and emergency departments each year, 30% are unnecessary.12