Candida parapsilosis bloodstream infection1

The T2Candida Panel was used to assess for the presence of disease and continuation of antifungal therapy, despite negative blood cultures.

Discussion


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.

Presentation

A 69-year-old man with history of testicular cancer, chronic kidney disease, anemia, gangrenous gallbladder, status post cholecystectomy, hypertension, hyperlipidemia, type 2 diabetes mellitus, paroxysmal atrial fibrillation, heart failure with reduced ejection fraction and implantable  cardioverter defibrillator (ICD), and aortic valve disease s/p mechanical aortic valve replacement who presented with fatigue, fever, diarrhea, emesis, febrile to 102.3 degree Fahrenheit with a blood pressure of 93/43 mm Hg, heart rate of 64 bpm, and respiratory rate of 18 breaths/min. 

Evaluation and Treatment Decision


Initial Diagnosis: Initially diagnosed with Candida parapsilosis bloodstream infection and treated with liposomal amphotericin B at 5 mg/kg/day. After developing acute kidney injury, therapy was changed to micafungin 150 mg intravenous (IV) daily.


Blood Cultures and Echography: Repeat blood cultures continued to grow Candida parapsilosis 10 days after admission. A trans-esophageal echocardiogram (TEE) revealed fibrin stranding on the mechanical aortic valve. Due to his multiple comorbidities, he was not deemed safe for surgical intervention.


Updated Therapy: Micafungin 150 mg IV daily and fluconazole 400 mg orally daily


Discharge Plan: A peripherally inserted central catheter (PICC) was placed, and the patient was discharged from the hospital to complete micafungin IV for 12 weeks plus fluconazole oral combination therapy.


T2Candida Panel – Initial Result: Six weeks after negative blood cultures, a T2Candida Panel was ordered, which still detected the presence of Candida parapsilosis. However, all repeat fungal blood cultures remained negative, and the patient had improved overall. 


T2Candida Panel – Second Result: 18 weeks after blood cultures became negative, a repeat T2Candida Panel was negative for any Candida species while on chronic suppression with fluconazole.


One year later, the patient currently remains alive and doing well on oral fluconazole suppressive therapy at 200 mg daily.


Decision making based on T2Candida Result


The T2Candida Panel was used to assess for the presence of disease and the continuation of antifungal therapy, despite negative blood cultures.

 

1. Ahuja, Tania, Karen Fong, and Eddie Louie. "Combination antifungal therapy for treatment of Candida parapsilosis prosthetic valve endocarditis and utility of T2Candida Panel®: A case series." IDCases 15 (2019): e00525.

Urinary Tract Infection: Suspected Sepsis

83-year-old male presented to the emergency department with urinary retention.

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.

Discussion

Upon admission, the patient was initially given ceftriaxone for the treatment of suspected urinary tract infection.  At the time of admission, he had blood and urine cultures obtained, and T2Bacteria ordered. At this institution patient selection for T2Bacteria testing was based on elevated lactate and/or procalcitonin in patients presenting to the emergency department with suspected bloodstream infections.

Empiric therapy was chosen to cover E.coli, the most common cause of urinary tract infection. This patient did not present with usual risk factors for P. aeruginosa; thus effective therapy against P. aeruginosa was not initiated until urine cultures demonstrated the growth of P. aeruginosa over 24 hours after admission (T2Bacteria results were not reported as this case was part of an observational study). Blood culture growth with P. aeruginosa was delayed >48 hours after admission.

Presentation

83-year-old male presented to the emergency department with urinary retention. Sepsis was suspected, and the patient was admitted with orders for blood and urine cultures, T2Bacteria, and antibiotics.

Patient Selection Criteria

Lactic acid 3.29

Evaluation and Treatment Decision

Diagnosis: Urinary tract infection

Empiric Therapy: Ceftriaxone

Ceftriaxone was chosen for coverage of common causative gram-negative pathogens of UTIs.

T2Bacteria Panel Result: Positive for P. aeruginosa and negative E. faecium, S. aureus, E. coli, and K. pneumoniae.  

Blood Culture Result: P. aeruginosa (>48 hours after admission)

Urine Culture Result: P. aeruginosa (24 hours after admission)

Decision making based on T2Bacteria Panel Result:

A rapid T2Bacteria result could have allowed for more informed treatment decisions, including the initiation of earlier effective therapy.

Community Acquired Pneumonia

Patient presented to the emergency department with shortness of breath, cough, fever and chills.

A rapid T2Bacteria result could have allowed for more informed treatment decisions, including the initiation of earlier effective therapy over 30 hours sooner.

Discussion

Upon admission, the patient was initially given ceftriaxone and azithromycin for the treatment of suspected community-acquired pneumonia. Due to the patient’s history of COPD, he was at risk for organisms such as MRSA (methicillin-resistant Staphylococcus aureus) in addition to the more common causes of community-acquired pneumonia such as Streptococcus pneumoniae and atypical organisms.

 

At the time of admission, he had blood cultures obtained, and T2Bacteria ordered. At this hospital, patient selection for T2Bacteria testing was based on elevated lactate and/or procalcitonin in patients presenting to the emergency department with suspected bloodstream infections.

Effective therapy against MRSA was not initiated until blood cultures demonstrated the growth of S. aureus over 30 hours after admission (T2Bacteria results were not reported as this case was part of an observational study). Had the T2Bacteria test been performed and result been reported immediately after collection, the patient could have been initiated on effective empiric therapy over 30 hours sooner.

Presentation

A 59-year-old male with a history of rectal cancer and COPD. The patient presented to the emergency department with shortness of breath, cough, fever, and chills. Sepsis was suspected, and the patient was admitted with orders for blood cultures, T2Bacteria, and antibiotics.

Patient Selection Criteria

Lactic acid 2.8 mg/dl

Procalcitonin 59 ng/ml

Evaluation and Treatment Decision

Diagnosis: Community-acquired pneumonia

Empiric Therapy: Ceftriaxone, Azithromycin

Ceftriaxone and azithromycin were chosen for coverage of common causative respiratory pathogens identified in community-acquired pneumonia.

T2Bacteria Result: Positive for S. aureus and negative E. faecium, P. aeruginosa, E. coli, and K. pneumoniae.  

Blood Culture Result: Methicillin-resistant Staphylococcus aureus (36-hour delay in species identification from time of blood culture collection)

Decision making based on T2Bacteria Result

A rapid T2Bacteria result could have allowed for more informed treatment decisions, including the initiation of earlier effective therapy over 30 hours sooner.

Suspected urinary tract infection

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.

Discussion

Upon presentation to the emergency department, the patient was initially given ceftriaxone for the treatment of suspected urinary tract infection. At the time of admission, she had blood and urine cultures obtained, and T2Bacteria ordered. Patient selection for T2Bacteria testing was based on procalcitonin in at the time of presentation.

The patient was discharged prior to blood culture resulting in positive for growth (T2Bacteria results were not reported as this case was part of an observational study). Had the T2Bacteria test been performed and result been reported immediately after collection, the patient could have potentially avoided premature discharge and readmission.

Presentation

A 91-year-old female presented to the emergency department with several day history of fever, chills, and nausea/vomiting. The patient was admitted with orders for blood cultures, T2Bacteria, urine cultures, and antibiotics.

Patient Selection Criteria

Procalcitonin 1.5 ng/ml in a patient suspected of bloodstream infection.

Evaluation and Treatment Decision

Diagnosis:  Suspected urinary tract infection

Empiric Therapy: Ceftriaxone x 1 dose

Ceftriaxone was chosen for coverage of common causative gram-negative pathogens identified in UTIs.

T2Bacteria Result: Positive for E. coli and negative for S. aureus, E. faecium, P. aeruginosa, and K. pneumoniae.

Blood Culture Result: E. coli on Day 2

Urine Culture Result: E. coli on Day 2

The patient was discharged in the morning of Day 2 prior to the availability of culture results. The patient returned to the ED on the next day with ongoing fever/chills and was readmitted.

Decision making based on T2Bacteria Result

A rapid T2Bacteria result could have allowed for more informed treatment decisions, including the continuation of antibiotic therapy and avoidance of readmission less than 24 hours after her initial premature discharge.

Deep-seated invasive candidiasis in a liver recipient

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.

Discussion

T2Candida retrospectively revealed C. albicans/C. tropicalis, even at the beginning of the process when the patient was asymptomatic. This case highlights the potential advantage of T2Direct Diagnostics aiding in the diagnosis of deep-seated infection in an immunosuppressed patient without confirmed infection, even before the onset of symptoms.

The two key findings were that arteritis and thrombosis of the hepatic graft resulted from an undocumented fungal infection in the explanted liver and that T2Candida was a suitable diagnostic tool for the diagnosis of deep-seated invasive candidiasis in the absence of positive blood culture results.

Presentation

A 57-year-old woman with insulin-dependent diabetes mellitus, primary sclerosing cholangitis, multiple bacteremic episodes, and recent liver transplant was admitted for sudden abdominal pain. After identification of intrahepatic abscesses the patient underwent a second liver transplant. Subsequently, non-purulent inflammatory tissue was observed in the liver with extensive clotting of the portal vein and hepatic artery and generalized hepatic ischemia. In the following hours, the patient developed graft failure, severe coagulopathy, and died.  

Evaluation and Treatment Decision

All of the cultures collected before death, including blood (obtained at admission and repeated 3 times during hospitalization), ascitic fluid at admission, and liver and abdominal tissues during the re-transplantation procedure, were sterile.

Final Diagnosis: Liver abscess

Empiric Therapy (May 31, 2017): Vancomycin, meropenem, caspofungin

T2Candida Panel Result: Retrospective T2MR performed on blood samples obtained on May 27th, May 31st, June 9th, June 16th, and June 26th showed C. albicans/C. tropicalis present in all samples.

Histology Result: Histopathology of explanted liver tissue revealed multiple ischemic areas with abundant filamentous fungal structures in their interior, and C. albicans was identified using multiplex PCR.

Decision making based on T2Candida Result

T2Candida result from May 27th (and subsequent results) could have permitted earlier focused therapy and aided with the diagnosis of invasive Candida infection. Unfortunately, the T2Direct Diagnostics results were not in use clinically and not obtained until after death.

Suspected aspiration pneumonia vs HCAP

Patient presents to the Emergency Department from nursing home with fever, dyspnea, and altered mental status.

Discussion

At the time of admission, this patient had blood cultures obtained, and T2Bacteria ordered. At Piedmont Columbus Regional, patient selection for T2Bacteria testing was based on >2 SIRS criteria PLUS suspected source of infection PLUS hypotension or altered mental status. This patient was positive for 2 of 4 SIRS criteria and had a suspected cause of infection and altered mental state, thus meeting criteria for testing.

Determination of the causative organism for this patient’s infection allowed optimization of the antibiotic regimen within 24 hours of presentation. The patient was not improving on empiric therapy and experienced clinical improvement after the switch from ceftazidime to meropenem. Additionally, clindamycin was discontinued on Day 2 and vancomycin was discontinued on Day 3 allowing for 5 days of therapy to be saved for clindamycin and 4 days of therapy to be saved for vancomycin. The patient continued to improve and was discharged back to the nursing home after meropenem therapy was completed.

Presentation

PS is a 69 y/o M who presented to the Emergency Department from a nursing home with a fever, dyspnea, and altered mental status. His initial lactic acid was 4.5. The treating physician saw him, and sepsis was suspected. PS was admitted with orders for labs, blood cultures, T2Bacteria®, and broad-spectrum antibiotics.

Patient Selection Criteria

SIRS criteria:

  • Temperature: 103.5˚F
  • Heart Rate: 130 bpm
  • Respiratory Rate: 20
  • WBC (initial): 19,920/mm3

Evaluation and Treatment Decision

Suspected aspiration pneumonia vs. HCAP

Empiric Therapy: Vancomycin, Clindamycin, Ceftazidime

T2Bacteria scheduled to result at 2030 on second shift. Result: K. pneumonia (time to result: ~5 hours), result reviewed by ID pharmacist next am

Blood Culture Result: Negative after 5-days incubation

WBC next am on Ceftazidime: 24,950/mm3 (worsening)

Decision making based on T2Bacteria Result

  1. Reviewed internal antibiogram. Changed Ceftazidime to Meropenem based on antibiogram percent susceptibility of 88% vs. 99%.
  2. Discontinue Clindamycin and vancomycin
  3. WBC next am after the switch to Meropenem: 10,960/mm3

 

Suspected Intra-abdominal sepsis

Patient presents with suspected sepsis

Discussion

Upon admission, the patient was initially given the broad spectrum antibiotics linezolid, aztreonam, and metronidazole for the treatment of suspected intra-abdominal sepsis. Due to the patient’s recent healthcare exposure, she was at risk for organisms such as MRSA (methicillin-resistant Staphylococcus aureus) and Pseudomonas aeruginosa in addition to the more common causes of intra-abdominal infection such as enterobacteriaceae and anaerobic organisms. 

At the time of admission, she had blood cultures obtained, and T2Bacteria ordered. At Lee Health patient selection for T2Bacteria testing was based on the NEWS (National Early Warning Score) scoring system. The NEWS score was developed to standardize the approach to detection of clinical deterioration in acutely ill patients in the United Kingdom, and a score of 7 or higher puts the patient in the high-risk category. This patient also was positive for 3 of 4 SIRS criteria and had a qSOFA score of 2, indicating a high risk of mortality.

Due to the negative blood culture (T2Bacteria results were not reported as this case was part of an observational study), the patient remained on empiric therapy for 5 days and then was changed to oral therapy and discharged 2 days later. Had the T2Bacteria result been reported, the patient could have been changed to meropenem to cover the E. coli and P. aeruginosa, allowing discontinuation of aztreonam. Given the S. aureus was negative, linezolid could have been discontinued as well. Discontinuation of these two antibiotics within the first 24 hours of admission would have led to ~$6,000 savings in antibiotic charges, and potentially led to earlier discharge on effective oral therapy.

Presentation

53-year-old immunocompromised, morbidly obese female with a recent history of surgery to drain an intra-abdominal abscess. The patient presented at the emergency department 8 days post-op with fever, chills, and abdominal pain. Sepsis was suspected, and the patient was admitted with orders for blood cultures, T2Bacteria®, and broad-spectrum antibiotics.

Patient Selection Criteria

SIRS criteria:

  • Temperature: 103.4
  • Heart Rate: 133 BP90/62
  • Respiratory Rate: 34
  • WBC: 6,800/mm3
  • NEWS Score: 9
  • QSOFA Score: 2

Evaluation and Treatment Decision

Diagnosis: Suspected Intra-abdominal sepsis

Empiric Therapy: Linezolid, Aztreonam, Metronidazole

Linezolid was chosen for gram-positive coverage due to challenges with vancomycin dosing in obese patients. Aztreonam was chosen for gram-negative coverage due to the patient history of penicillin allergy. Metronidazole was chosen for anaerobic coverage.

T2Bacteria Result: Positive for E. coli and P. aeruginosa and negative for S. aureus, E. faecium, and K. pneumoniae. (SA -, PA + & EC +); T2Bacteria results were not reported as this case was part of an observational study.  

Blood Culture Result: Negative

Decision making based on T2Bacteria Result

The negative S. aureus result meant that the patient did not have MRSA and therefore, linezolid could have been discontinued after the first dose when the T2Bacteria result was available, a 4.5-day reduction in linezolid. The patient’s therapy could have been more targeted gram-negative coverage by switching to meropenem to cover E. coli and P. aeruginosa

Identify sepsis causing pathogens in less than 5 hours while blood cultures incubate

  • March 13, 2019
  • All

Imagine species identification for some of the most common and deadly sepsis-causing pathogens— without having to wait 1 to 5 days or more for blood culture results. 

Patient Health

Early targeted therapy improves patient outcomes; every hour delay of effective antibiotic therapy increases mortality by almost 8% in patients with septic shock. A positive ESKAPE or Candida test result may enable rapid targeted treatment and prevent a serious bloodstream infection from progressing to sepsis. Faster identification of sepsis causing pathogens means patients are on targeted therapy faster— saving costs for unnecessary antibiotics— and enabling clinicians to treat the source of infection faster. In clinical studies, the T2Bacteria Panel (RUO) identified opportunities to escalate and de-escalate with confidence in patients who were ineffectively treated. (T2-704-4/18 for reference 1) Read more on how Lee Health made a positive impact on patient health.

Laboratory

Sepsis is defined as a life-threatening medical emergency by the CDC. New direct-from-whole blood T2Direct Diagnostics™ are the only FDA-cleared tests proven to complement traditional blood culture methods by identifying the most common and deadly organisms in 3 to 5 hours. Studies demonstrate both the T2Bacteria® Panel and T2Candida® Panel are able to detect some of the most common and clinically relevant pathogens at a limit of detection (LoD) as low as 1 CFU/mL and with a high degree of sensitivity and specificity. The easy to use T2Dx® Instrument is powered by T2MR technology, and is not only easy to use but also fits within the most space-constrained environment. The fully automated, walkaway instrument is a clinical multiplex benchtop diagnostic system capable of running tests directly from 3-4 mL of whole blood.

Improved Stewardship Goals

Antibiotic resistance is a growing concern worldwide, and a major public health threat. Overuse and inappropriate antibiotic use in patients are a root cause, as patients are being treated for infections empirically without knowing if they are actually infected, often exposing them to incorrect or unnecessary antibiotic therapy. This greatly decreases their chances of survival and increases the problem of antimicrobial resistance. Stewardship Committees are chartered with optimizing the utilization of antimicrobials for the best patient care while minimizing unintended consequences associated with antimicrobial exposure. The inclusion of faster ID of sepsis causing pathogens as part of a hospital’s stewardship initiatives can enable faster time to improved patient outcomes and de-escalation of antimicrobial drug use. Patient outcomes include reduced hospital and ICU length of stay and de-escalation of unnecessary therapies. More effective use and better cost management of antimicrobial drugs, with the ability to make rapid adjustments can reduce resistance while improving antimicrobial stewardship and potentially reduce morbidity and mortality outcomes resulting in reducing the cost of sepsis management. Read more how labs are improving stewardship at Riverside Hospital.

1. Kumar, A, et al. Critical Care Medicine, 2006.

19th-Century diagnostic methods make it too easy for “ESKAPE” pathogens to escape

  • December 1, 2018
  • All

In 2004, microbiologist Carl Nathan, M.D., wrote in a Nature commentary that:

"Treating infections with pathogen-specific rather than broad-spectrum antibiotics (whenever possible) will require prior, rapid, accurate and specific diagnosis. It makes no sense to use 21st-century technology to develop drugs targeted at specific infections whose diagnosis is delayed by 19th-century methods."1

In the decade and a half since Dr. Nathan wrote these words, the standard of care has remained mired in “19th-century methods.” Despite important diagnostic improvements made to post-blood culture methods, the days-long culturing of blood remains the foundation for pathogen-specific identification. Since clinicians cannot wait days to act when confronted with a patient suspected of sepsis, the standard of care remains empiric therapy. In the 2018 book, Superbugs: An Arms Race Against Bacteria, Lord Jim O'Neill and his coauthors describe the limitations of empiric therapy:

"Doctors usually treat patients using empirical diagnosis, which is little more than an educated guess based on a clinical assessment of the patient’s symptoms, history, and profile. This system is often not good enough to distinguish between bacterial and viral infections, or even to tell if the patient has an infection at all. If a bacterial infection is diagnosed, there is no way to determine if the bacteria are resistant or susceptible to standard treatments using empirical diagnosis since they produce identical symptoms, and our current diagnostic tests to distinguish between them take two days."2

Empiric therapy works for many patients, it has been demonstrated that approximately 60% of patients are on initial effective therapy, but there remain significant opportunities for improvement.3 A recent 1,400 patient, 11-site clinical trial led by investigators at UPMC found similar gaps: 2 in 3 patients were not on effective therapy at hour zero, and 1 in 5 patients were still on ineffective therapy 24 hours later.4

An Easy “ESKAPE”

Frighteningly, many patients who are not initially on effective therapy are battling a prevalent and deadly “ESKAPE” pathogens that cause the most worry for clinicians. The opportunistic ESKAPE pathogens were dubbed the acronym due to the bacterial pathogens being known for their ability to “escape” response to broad-spectrum antibiotics. The ESKAPE pathogens have been primary beneficiaries of “19th-century methods” of diagnosis. Of the six ESKAPE pathogens, four of the most common, E. faecium, S. aureus, K. pneumoniae, and P. aeruginosa, make up approximately 90% of all ESKAPE bloodstream infections.5  The Infectious Diseases Society of America (IDSA) elevated the profile of these pathogens with a report called “Bad Bugs, No Drugs” providing the ESKAPE name and highlighting the potential health crisis.6  Most of these pathogens are multidrug resistant and increasingly resistant to common empiric therapy such as the combination Vancomycin/Piperacillin-Tazobactam.

The 21st-Century Diagnostic for Fighting ESKAPE Pathogens

Enter the T2Bacteria Panel. The first and only FDA-cleared technology to detect prevalent and deadly ESKAPE pathogens in 3 to 5 hours – directly in whole blood! This breakthrough test is shown to provide results 2.5 days faster than the current standard of care.

Direct from whole blood technology is ushering in a new era of diagnostics, one befitting of 21st-century technology advantages described by Dr. Nathan in 2004.

Don’t wait another decade – it’s time to use 21st-century technology! Find out what it can do for you here.

……………………………………….

1. Nathan, C. (2004). Antibiotics at the crossroads. Nature431(7011), 899.
2. Hall, W, et al. (2018) Superbugs: An Arms Race Against Bacteria. Cambridge, MA.; Harvard University Press
3. Buehler, SS, et al. Clinical microbiology reviews, (2016). 29(1), 59-103.
4. T2Bacteria Pivotal Clinical Study 2018. Manuscript under review.
5. Karlowsky, J. et al. Annals of Clinical Microbiology and Antimicrobials, (2004). 3:7.
6. Infectious Diseases Society of America. (2008, December 9). No ESKAPE! New Drugs Against MRSA, Other Superbugs Still Lacking. ScienceDaily.  

3 Lessons for Sepsis Committees with Dr. Sandy Estrada

  • November 15, 2018
  • All

The following is edited from a conversation with Sandy Estrada, Pharm.D., BCPS, Vice President, Medical Affairs, T2 Biosystems. Dr. Estrada was previously an Infectious Diseases Clinical Pharmacist for Lee Health in Ft. Myers, FL for 13 years where she served as the Co-Director of Antimicrobial Stewardship, Director of the ID Pharmacy Residency Program, and as a member of the sepsis committee.

Sepsis Committees Get It Right With Direct Patient Care Staff Involvement:

Sepsis committees often make a priority of identifying or hiring a sepsis coordinator. This position is typically held by a nurse or emergency department clinician. This leadership role for frontline caregivers helps center the committee’s actions on a passion for patient care and a desire to seek breakthroughs that can reduce sepsis mortality and improve patient outcomes.  

Integration with Existing Hospital Committees is Key:

Every sepsis committee should be conscious of other on-going committees and how to maximize its influence and expertise to drive improved patient care.  Many sepsis committees are relatively recent creations. At our hospital, the stewardship committee had been in existence for about a decade when the sepsis committee was first organized. The stewardship committee’s mission of fast and appropriate targeted antibiotic utilization is highly aligned with a core sepsis committee priority. In addition, many individuals were members of both the sepsis and the stewardship committees. Our sepsis committee was very successful when it leveraged and accelerated the work of existing committees, like stewardship.

You Must Get the Right Players at the Table:

An effective sepsis committee must be collaborative and have a balanced representation by clinical and administrative leaders. A purely clinical group is at risk of not having support from administration for proposed changes, while a purely administrative group may not have buy-in from the clinicians necessary to implement any changes. In addition, it is important to have someone from the IT department represented; they are key in making sure protocols and order sets get electronically implemented in a timely fashion.

“Killing the Kidneys” with Empiric Therapy?

  • October 17, 2018
  • All

A recent Pharmacy Practice News article ran with the jarring headline: “Killing the Kidneys to Save the Patient.”1 It drives at an issue facing many hospitals today: widespread use of antibiotics are at times negatively impacting kidney function – because hospitals have such limited data, they struggle to make timely appropriate antibiotic therapy choices. 

For millions of patients at risk of sepsis each year, the standard of care is to turn immediately to broad empiric antimicrobial therapy when a patient is suspected of a sepsis-related infection: dose patients with vancomycin and piperacillin-tazobactam, or a similarly broad-spectrum coverage. This is a pre-emptive strike while they wait for a diagnostic result that can identify the causative pathogen of the bloodstream infection – or if there is an infection at all. In fact, over 50% of the time, there is no infection at all! “Vanc” and “pip/tazo,” for example, are relatively cheap and effective – and necessary for a patient’s survival if they have a gram-positive infection like MRSA or a gram-negative bacteria like Pseudomonas aeruginosa or E. coli. When the mortality rate for sepsis rises ~8% each hour the patient goes untreated, the results of undertreatment are devastating.2 So this practice is the right thing to do, but it has consequences.

Kidneys are often paying the price. Broad-spectrum empiric therapy can cause nephrotoxicity or acute kidney injury in patients. Acute kidney injury causes excess waste products in blood and makes it challenging for kidneys to maintain the right balance of fluid in the body, and may negatively affect other organs. Some patients may be required to go on dialysis to help replace kidney function. A recent study demonstrated that vancomycin plus piperacillin-tazobactam increases the odds of acute kidney injury by threefold, and acute kidney injury increases hospital length of stay by approximately 3.5 days and costs by $7,500.3

Enter the heroes!
Every day, antimicrobial stewardship teams face pressure to safely de-escalate or discontinue broad-spectrum antibiotics when they are not needed. How can you convince clinicians that it is safe to change therapy without any diagnostics to guide the decision… because conventional blood culture results take days?

In part to reduce harm to the kidneys, hospitals and stewardship teams are turning to new, faster diagnostics like the FDA-cleared T2Bacteria® Panel. This test provides direct-from-whole-blood infection identification in 3 to 5 hours, without the wait of blood culture.

As described in a new white paper from Lee Health, T2Bacteria is a useful tool to support five antimicrobial stewardship goals including optimizing empiric therapy within hours.4 T2Bacteria research results demonstrate the panel can help rule out of P. aeruginosa and/or S. aureus within hours.

Don’t miss the two detailed case studies where therapy could have been narrowed and optimized days sooner, saving money and reducing the risk of adverse side effects – including the potential to reduce acute kidney injury.

……………………………………….
1. Rosenthal, M. Pharmacy Practice News. July 2018.
2. Kumar, A, et al. Critical Care Medicine,(2006). 34(6), 1589-1596.
3. Luther, M, et al. Open Forum Infectious Diseases, Volume 3, Issue suppl_1, 1 December 2016, 1805, https://doi.org/10.1093/ofid/ofw172.1353
4. Weisz, EE, et al. Stewardship and the T2Bacteria® Panel: Early Research Experience at a Community Hospital. White Paper. September 2018.

World Sepsis Day: Sepsis survivors that inspired us this year

  • September 12, 2018
  • All

Welcome to the first ever T2Blog, an initiative that we take excitedly and seriously. We are excited to create a space where readers can keep up with T2. We are privileged to play a part in fighting sepsis with game-changing diagnostic technology that detects bloodstream infections and may prevent the progression to sepsis. Sepsis is a serious condition and we are serious about having a stake in the sepsis community. Throughout these blogs, we will address inspiring patient stories, challenges in sepsis management, T2’s technology, initiatives, and advancements in the field. So here goes! 

Day to day, it’s easy to get bogged down in the essential, but sometimes seemingly disconnected details of diagnostic tests: from reagent primers and probes to sensitivity calculations to getting the exact right amount of cells in a spiked blood sample. World Sepsis Day is an important reminder to step back and connect with the larger cause that fuels all these activities at T2: to save lives of patients with sepsis and help them return home to their families instead of the tragic, and often avoidable, alternative. This year, our team was fortunate to meet and support many strong sepsis survivors who have dedicated their lives to raising awareness by telling their personal stories in order to help others avoid the same tragic consequences. Their passion, commitment, and firsthand experience have helped fuel T2 during one of the most exciting and pivotal years in our company’s history.

In January, we met with Audrey Leishman via video and her husband, PGA Tour Professional Marc Leishman, to learn about Audrey’s battle with sepsis and her outstanding work with the Begin Again Foundation to support sepsis survivors get back on their feed.

Over the summer, Mary Millard visited our team in Lexington, Massachusetts to share her story. Mary is an inspiration with her willingness to share her personal story with such passion to improve care for similar patients. What could have been a routine cardiac procedure became a lifelong health battle after a bacterial infection was misdiagnosed and incorrectly treated for too long. Her story brings much-needed attention to the devastating health effects of sepsis and hospital-acquired infections. Mary gave permission to share her experience with sepsis – and the impact she could have had with earlier identification and treatment of the increasingly resistant Pseudomonas aeruginosa that forever changed her life.

We were inspired by the passion of the family of Emily Edwards, whose life was tragically cut short by sepsis. Her family is part of the National Family Council on Sepsis and hosted a Stepping Out Sepsis 5K in May in Dracut, Massachusetts. We were proud that team orange was there to support their important work!

This month, our team at T2 is again “Spiking Out Sepsis” on the front lawn at Hartwell Avenue with a volleyball tournament where the proceeds go to the Sepsis Alliance, an organization doing such valuable work to raise awareness.  

Thanks to all the individuals and organizations who are part of the fight against sepsis. Together, we can help eradicate preventable sepsis deaths!

  • Sign Up for our Blog

  • Media Contact

    Gina Kent
    610-455-2763
    gkent@vaultcommunications.com

    Media Center

  • According to the CDC, of the 154 million prescriptions for antibiotics written in doctors' offices and emergency departments each year, 30% are unnecessary.12

  • Publications

    Over 200 studies published in peer-reviewed journals have featured T2MR in a breadth of applications.

    Read Now!
  • JOIN THE MAILING LIST!