Sepsis in an Immunocompromised Patient with a Central Line

An immunocompromised patient was admitted after developing fever and rigors.

Discussion

This high risk, immunocompromised patient was initially treated with ceftriaxone. The rapid T2Bacteria result for pseudomonas allowed for the escalation of therapy to meropenem and amikacin. Additionally, the positive T2Bacteria result prompted the removal of the central line as the suspected source of the infection. The culture from the catheter tip confirmed P. aeruginosa, five days after the initial P. aeruginosa result from T2Bacteria. Rapid species identification allowed for rapid escalation of therapy. Without the availability of T2Bacteria, the patient may have remained on inappropriate therapy for days until further clinical deterioration may have led to an empiric switch/broadening of therapy.  

This case highlights how T2Bacteria can guide early treatment by rapidly identifying the causative pathogen in sepsis cases that are missed by blood cultures. T2Bacteria may be particularly useful in hematology/oncology patients with new-onset of bloodstream infection and/or sepsis due to the heavy antibiotic pre-exposure and the critical importance of getting therapy right on Day 1.

Presentation

An immunocompromised patient was admitted after developing fever and rigors approximately three months after stem cell transplant for treatment of AML. He was given ceftriaxone empirically upon admission. He had been diagnosed with AML the previous year and successfully underwent a stem cell transplant with a normal post-transplant course.

Patient Selection Criteria

Sepsis in an immunocompromised patient with a central line

Evaluation and Treatment Decision

Diagnosis: Sepsis

Empiric therapy: Initially ceftriaxone in addition to the continuation of prophylactic trimethoprim/sulfamethoxazole and posaconazole.

T2Bacteria: Positive Pseudomonas aeruginosa

Blood Culture Result: No growth; CVC tip culture: P. aeruginosa

Decision Making Based on T2Bacteria Results

The rapid T2Bacteria result supported the rapid escalation of therapy from ceftriaxone to meropenem and amikacin. The patient also received antibiotic lock therapy with amikacin preceding removal of the central line. The patient completed therapy and was discharged home with no complications.

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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