A patient was admitted with a two-day history of right lower quadrant pain, fever, and vomiting
Discussion
This case highlights the benefit of rapid species identification with the T2Bacteria Panel and the potential prevention of additional sequelae with a premature discharge from the ED.
Presentation
An elderly patient was admitted with a two-day history of right lower quadrant pain, fever, and vomiting. A set of blood cultures and a T2Bacteria were drawn.
The patient received a fluid bolus and empiric antibiotics and started to stabilize, tolerating, orals, and was asking to go home. The patient was discharged after being in the ED for approximately 6 hours and given oral antibiotics with a follow-up in 2 days with a primary care provider due to her suspicious urinalysis. After the patient was discharged from the emergency department, the T2 resulted, approximately 4.5 hours after the draw.
Patient Selection Criteria
A septic patient presenting in the Emergency Department
Evaluation and Treatment Decision
Diagnosis
Suspected UTI
Empiric Therapy
The patient was started on ceftriaxone
T2Bacteria Panel Result
Positive for E. coli
Blood Culture Result
Positive for E. coli
Urine culture
Positive for E.coli
Hospital course and decision making based on the T2Bacteria Result
A rapid T2Bacteria positive for E. coli prompted the ED team to bring the patient back to the hospital for admission, which potentially prevented additional clinical complications.
Once the patient was re-admitted, they began to spike fevers. Approximately 12 hours after re-admission, the blood cultures turned positive. A Gram-stain was done, and a Gram-negative was identified (about 14 hours after the T2 resulted). At the same time, the urine culture turned positive, confirming the source as genitourinary. The patient was administered IV ceftriaxone until discharge, approximately 2.5 days after admission. Blood cultures were finalized approximately three days after the initial blood draw confirming the E.coli. The patient was sent home on oral antibiotics to complete her course of therapy.
