Septic Shock Secondary to Pyelonephritis

A 55-year-old male presented to the hospital from an outside facility with sepsis secondary to pyelonephritis.

Discussion

This case highlights not only T2Bacteria’s ability of rapid identification but also the capability to detect the causative organism in the presence of antibiotics. The patient, in this case, received a dose of ceftriaxone and azithromycin before the blood cultures and T2Bacteria were drawn. Bloodstream infection was missed by blood culture but was identified with rapid detection provided by the T2Bacteria Panel. The use of T2Bacteria, in this case, allowed an early confirmation of effective antibiotic therapy.

Presentation

A 55-year-old male presented to the hospital from an outside facility with sepsis secondary to pyelonephritis. Before transfer, the patient received one dose of ceftriaxone and azithromycin. He was subsequently admitted to ICU with septic shock and acute renal failure, which required initiation of continuous renal replacement therapy. Blood cultures, urine cultures, and T2Bacteria Panel were obtained.

Patient Selection Criteria

Critically ill patients with sepsis/septic shock and/or elevated procalcitonin

Evaluation and Treatment Decision

Diagnosis: septic shock secondary to pyelonephritis

T2Bacteria Result: Positive for E. coli

Blood Culture Result: no growth

Urine Culture Result: E. Coli

Empiric Therapy: cefepime

Decision making based on T2Bacteria Result

A rapid T2Bacteria result allowed for early diagnosis of E. coli bacteremia and the confirmation of effective empiric antibiotic therapy. T2Bacteria detected E. coli directly from whole blood in approximately 4 hours after the patient presented to the hospital. The positive T2Bacteria result was obtained hours before the blood cultures were even able to be sent to an off-site core lab to be processed, which ultimately did not grow.

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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