T2Bacteria Result Used to Alter Therapy

An elderly patient presented to the ED with a day-long history of fever, shaking, suprapubic pain, vomiting, and diarrhea

Discussion

This case highlights not only T2Bacteria’s ability of rapid identification but also the capability to detect the causative organism and use the result to de-escalate therapy.

Presentation

An elderly patient presented to the ED with a day-long history of fever, shaking, suprapubic pain, vomiting, and diarrhea.  A urinalysis and urine culture were ordered.  The patient was diagnosed with gastroenteritis, given antiemetics, and subsequently sent home. The following morning the urine culture resulted, growing a Gram-negative rod, and the patient was called to return.  Once they returned, they stated they were feeling slightly worse and also had a low-grade fever, elevated heart rate, and a WBC of 13.6.  A set of blood cultures and a T2Bacteria were drawn, and the patient was transferred to the floor.

Patient Selection Criteria

A septic patient presenting in the Emergency Department

Evaluation and Treatment Decision

Diagnosis: Suspected infection r/o urinary or abdominal infection as the source

Empiric Therapy: The patient was started on levofloxacin

T2Bacteria Panel Result: Positive for E. coli

Blood Culture Result: Negative to date

Urine Cultures: Positive for E.coli

Hospital Course and Decision Making Based on the T2Bacteria Result

Once the patient was transferred to the floor, the T2Bacteria turned positive for E.coli. Given that the source was likely genitourinary, the clinicians utilized the T2Bacteria result to identify the specific organism; and based on the signs and symptoms of a UTI, therapy was changed to ceftriaxone.  The change was made to comply with the FDA’s recommendations for the treatment of a UTI but also to avoid complications, which are known to occur in elderly patients with the use of fluoroquinolones for UTIs.  The patient vastly improved and was discharged two days after admission with oral antibiotics to finish their course of therapy.

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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