An 81-year-old patient with a complicated medical history was admitted to the hospital for a tracheoesophageal fistula repair.
Discussion
This case highlights the benefit of the T2Bacteria Panel’s turnaround time for species identification. Tigecycline has been associated with high rates of gastrointestinal adverse events such as nausea and vomiting and does not provide adequate coverage of P. aeruginosa. The rapid result provided by T2Bacteria allowed for discontinuation of Tigecycline after only one dose. Additionally, amikacin was added as an antimicrobial known to be effective against P. aeruginosa based on the institution’s antibiogram.
Presentation
An 81-year-old patient with a complicated medical history including diabetes, dysphagia, Parkinson’s Disease, and a history of multiple hospitalizations over the last six months was admitted to the hospital for a tracheoesophageal fistula repair. The patient developed signs and symptoms of pneumonia several days post-operatively. T2Bacteria, blood, sputum, and tracheostomy cultures were obtained after the patient was started on ceftolozane/tazobactam and tigecycline empirically.
Evaluation and Treatment Decision
Vitals
Temp- 36.5, HR- 69BPM
Available labs
WBC- 21.7K CRP- 22.2 mg/dl, PCT – 2.48ng/mL.
T2Bacteria Result
Positive for P. aeruginosa and negative for all other bacterial targets (results available at 5h2min)
Blood Culture Result
no growth reported
Other cultures
Tracheostomy Exit Site: P. aeruginosa, C. albicans; Rectal swab: E. faecium, P. aeruginosa
Decision Making Based on T2Bacteria Results
The patient’s therapy was adjusted based on the T2Bacteria Panel result. Tigecycline was discontinued and the patient was started on amikacin in addition to ceftolozane/tazobactam in order to provide effective coverage for P. aeruginosa.
