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.
