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.

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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