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.
Presentation
A 45-year-old male presented to an acute care hospital with a perforated small bowel. He developed septic shock requiring intubation and was effectively treated with broad-spectrum antibiotics. He became hemodialysis-dependent following this episode. Eventually, a tracheotomy was performed, he was initiated on TPN, and transferred to a long-term acute care (LTAC) hospital.
On admission to the LTAC, he was stable, and a draining fistula was noted. On Day 3 of LTAC admission, the patient developed new fevers and leukocytosis.
Patient Selection Criteria
New-onset suspected sepsis in a patient with risk factors for candidemia
Evaluation and Treatment
Diagnosis
Suspected sepsis and intra-abdominal infection
Empiric Therapy
Vancomycin, Meropenem, and Fluconazole initiated
Blood Culture Result
Negative
T2Candida Panel Result
C. parapsilosis
Decision making based on the T2Candida Result
The nurse and pharmacy were given the results of the T2Candida test. They alerted the infectious diseases pharmacist who, in turn, called the infectious diseases physician. The infectious diseases physician stopped the vancomycin and meropenem. Antibiogram data from this institution showed greater than 50% fluconazole resistance in C.parapsilosis blood isolates, so fluconazole was changed to micafungin for a 14-day course.
