Sepsis Secondary to UTI

Discussion

In this case, rapid detection of bloodstream infection by the T2Bacteria Panel could have allowed for more informed treatment decisions, including early initiation of effective antibiotic therapy, potentially leading to prevention of clinical deterioration and avoidance of readmission.

Presentation

64-year-old patient admitted with liver failure, hepatic encephalopathy and respiratory failure requiring intubation. Blood cultures were ordered as part of an infectious workup, but were negative and no antibiotics were administered. Patient was discharged after 9 days of hospitalization then re-presented the following day with hypotension and acute respiratory failure requiring intubation.

Patient Selection Criteria

Patients with sepsis presenting to ICU from the Emergency Department

Evaluation and Treatment Decision

Diagnosis: Sepsis secondary to UTI

T2Bacteria Panel Result (obtained during initial admission with blood cultures as part of observational study): Positive for S. aureus

Blood Culture Result (obtained during initial admission): S. vestibularis (1/2 bottles)

Blood culture Result (obtained during re-admission): No growth

Urine Culture Result (obtained during re-admission): S. aureus

Nasal PCR (obtained during re-admission): Positive for MRSA

Empiric Therapy (initiated during re-admission): Ceftriaxone; vancomycin added on day 3 of re-admission following urine culture results and clinical deterioration of patient

Decision making based on T2Bacteria Panel Result

T2Bacteria and blood cultures were obtained for infectious workup during the patient’s initial admission. T2Bacteria results were not reported as this case was part of an observational study. Antibiotics were not administered and the patient was discharged after a nine day hospitalization. Less than 24 hours later, the patient was re-admitted with acute respiratory failure and sepsis secondary to suspected UTI and was found to have S. aureus in urine and nasal PCR positive for MRSA. If the T2Bacteria Panel had been performed and result reported immediately after collection, it could have prompted the physician to target therapy 11 days sooner and potentially avoid readmission.

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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