Patient with Risk Factors for Candidemia

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.

 

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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