Possible Pneumonia

The patient presented to the Emergency Department with acute respiratory failure and was admitted to the ICU with orders for blood cultures, T2Bacteria, and empiric antibiotics.

• November 1, 2019
• Case Studies

Discussion

In this case, rapid detection of bloodstream infection by the T2Bacteria Panel could have allowed for more informed treatment decisions, including the continuation of effective antibiotic therapy, which may have led to the prevention of clinical deterioration.

Presentation

The patient presented to the Emergency Department with acute respiratory failure and was admitted to the ICU with orders for blood cultures, T2Bacteria, and empiric antibiotics.

Patient Selection Criteria

Patients with sepsis presenting to ICU from the Emergency Department

Evaluation and Treatment Decision

Diagnosis: Possible pneumonia

T2Bacteria Result: Positive for P. aeruginosa

Blood culture Result: No growth

Respiratory Culture #1 Result: Enterobacter (resistant to cefepime, susceptible to levofloxacin)

Respiratory Culture #2 Result: P. aeuriginosa (intermediate resistance to levofloxacin, susceptible to cefepime and imipenem)

Empiric Therapy: cefepime, vancomycin

Decision making based on T2Bacteria Result

T2Bacteria and blood cultures were obtained for an infectious workup at the time of admission (T2Bacteria results were not reported, as this case was part of an observational study).

Empiric antibiotics included cefepime and vancomycin. Antibiotic therapy was changed to levofloxacin on day 5 of hospitalization to target the Enterobacter species, which was identified in the first respiratory culture. The patient continued to decline, and a second respiratory culture was obtained on day 10 of hospitalization, which grew P. aeuriginosa with intermediate resistance to levofloxacin. Antibiotics were then escalated to meropenem to treat both respiratory pathogens that were isolated in cultures.

Had the institution known of the rapid T2Bacteria result of P. aeuriginosa, the physician may not have changed therapy to levofloxacin considering the patient’s risk factors and local resistance patterns. Clinical deterioration could potentially have been avoided.