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.
The T2Candida Panel was used to assess for the presence of disease and continuation of antifungal therapy, despite negative blood cultures.
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.
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.
A rapid T2Bacteria result could have allowed for more informed treatment decisions, including the initiation of earlier effective therapy over 30 hours sooner.
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.
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.