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T2Bacteria enabled the detection of polymicrobial infection and the detection of a subsequent Enterococcus faecium infection in a patient where cultures remained negative. Rapid species identification led to targeted therapy and eventual discharge.

Klinik Favoriten | Vienna, Austria

Patient History

Age and Sex: 53-year-old male
History: The patient had no history of chronic diseases
Presentation: The patient was admitted to the hospital with COVID-19 and respiratory failure and was mechanically ventilated
Risk Factors: The patient had multiple risk factors for infection.

• Presence in ICU
• Broad spectrum antimicrobial therapy
• Mechanical ventilation

Evaluation and Treatment

Initial presentation
The patient was admitted to the hospital eight days after the onset of symptoms and then admitted to the ICU with COVID-19 and respiratory failure. The patient was mechanically ventilated.

Weaning was complicated due to ventilator-associated pneumonia.

T2Bacteria Result
The T2Bacteria Panel was positive for Staphylococcus aureus and Escherichia coli, and targeted therapy was initiated before culture results were returned.

Culture Result
A bronchoalveolar lavage sample was also positive for Staphylococcus aureus and Escherichia coli.

Patient Deterioration
10 days later, the patient developed septic shock from an unknown source. Several blood, bronchoalveolar, and urine cultures were taken, but no growth occurred.

Another T2Bacteria Panel was run and was positive for Enterococcus faecium, leading to targeted therapy. A transesophageal echocardiogram revealed endocarditis of the native aortic valve.

Day 42
After 42 days in the ICU, the patient was discharged to a rehabilitation facility.

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T2Candida enabled the detection of candidemia 29 hours before a positive blood culture was returned. Early detection allowed for the rapid initiation of antifungal therapy in a critically ill COVID-19 patient.

Lee Health | Fort Myers, Florida

Patient History

Age and Sex: Elderly Male
History: Patient was admitted to the hospital with confirmed COVID-19. His past medical history included Type 2 diabetes mellitus and hypertension
Presentation: The patient required oxygen support via nasal cannula. A chest radiograph showed bibasilar infiltrates and initial blood cultures were negative.
Risk Factors: The patient had multiple risk factors for candidemia during hospitalization.

• Presence in ICU
• Broad-spectrum antimicrobial therapy
• Immunosupressing medications

Evaluation and Treatment

Day 1
The patient was initiated on azithromycin and methylprednisolone, was given one dose of convalescent plasma

Day 2
Patient was administered 1 dose of tocilizumab (8mg/kg)

Day 3
Patient was intubated for worsening respiratory status

Day 14
Patient developed new fever, chest x-ray showed increased opacities, broad-spectrum antimicrobial therapy was initiated for suspected bacterial pneumonia

Day 15 & 16
Fever escalates (Tmax 101.9F and 103F, respectively). Additional blood cultures were obtained and T2Candida was ordered. T2Candida was positive for Candida albicans/Candida tropicalis 29 hours before the positive blood culture. On the evening of day 16 anidulafungin was initiated

Day 18
Patient defervesced

Day 30
Patient was discharged to a long-term acute care center

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1. Cubillos, A., et al. CAP, 2021

A 20-year-old patient with a history of lupus presented to the emergency department with shortness of breath.

Discussion

This case highlights the benefit of T2Bacteria’s rapid bacterial species identification, which enabled early identification of the causative pathogen in a critically ill, immunocompromised patient. Bacterial infections commonly occur following the successful treatment of viral infections.  These infections are often missed due to prior antimicrobial use, especially in at-risk patient populations, leading to treatment delays and negative clinical outcomes.

Presentation

A 20-year-old patient with a history of lupus presented to the emergency department with shortness of breath. They had recently recovered from influenza and were otherwise asymptomatic. The patient did not have a previous history of infections, but due to severe shortness of breath of uncertain etiology, was admitted. The patient’s condition worsened, leading to intubation and transfer to the intensive care unit overnight.

Evaluation and Treatment Decision

Day 1: The patient was started on ceftriaxone and azithromycin to cover for possible pneumonia due to rapid deterioration upon admission to the ICU.
Day 2: Due to the lack of clinical improvement,  the intensivist ordered a T2Bacteria Panel and blood cultures, as well as respiratory cultures.

T2Bacteria Result

Positive for P. aeruginosa

Blood Culture

Negative

Respiratory Culture

Positive for P. aeruginosa (36 hours after T2Bacteria result)

Hospital Course and Decision Making Based on the T2Bacteria Result

Based on the T2Bacteria result, the patient was started on meropenem to cover P. aeruginosa and the ceftriaxone was discontinued. The patient began to improve on Day 3 and continued to improve slowly over the remainder of the week. The patient was discharged on Day 7 in stable condition.

A 67-year-old patient had experienced infections, including multi-drug resistant pneumonia, sepsis, and C. difficile colitis during admission.

Discussion

This case highlights the benefit of T2Candida’s rapid fungal species identification, which allowed for the continuation of appropriate antifungal therapy as well as the discontinuation of unnecessary broad-spectrum antibiotics, resulting in clinical improvement.

Presentation

A 67-year-old patient with a history of ALS and chronic respiratory failure was being managed at a long-term acute care (LTAC) facility for the last five months. The patient had experienced infections, including multi-drug resistant pneumonia, sepsis, and C. difficile colitis during admission.

Evaluation and Treatment Decision

Day 1: An infectious disease (ID) physician was called early morning because the patient was experiencing a new symptom of hypothermia. Multiple cultures were obtained, and the patient was started on empiric antibiotic treatment with IV vancomycin, meropenem, polymyxin B, and anidulafungin.

Day 2: The stewardship team recommended that anidulafungin be changed to fluconazole. The ID physician ordered a T2Candida Panel and continued anidulafungin until the results were available.

T2Candida Result

Positive for C. glabrata/C. kruseii.

Fungal Culture Result

no growth reported

Hospital Course and Decision Making Based on the T2Candida Result

On the third day, based on the T2Candida Panel results that were positive for C. glabrata/C. krusei– anidulafungin was continued. On day 5, meropenem and polymyxin B treatment were discontinued, and on day 6, vancomycin was discontinued.

The patient improved and remained off of systemic antibiotic treatment following this episode of fungal sepsis. The patient was transferred in stable medical condition to a subacute facility.

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.

An elderly patient presented to the ED with nausea, myalgia, and insomnia.

Discussion

This case highlights the benefit of the T2Bacteria Panel’s ability to provide species identification in the presence of antimicrobial therapy rapidly.  Using T2Bacteria enabled the identification of E.coli in a patient on inadequate therapy for a urinary tract infection (UTI).

Presentation

An elderly patient presented to the ED with nausea, myalgia, and insomnia. The patient had seen their primary care provider earlier in the day and was given a three-day course of antibiotics for a suspected UTI.  Once in the ED, the patient received IV fluids and antiemetics. At that time, blood cultures and a T2Bacteria Panel were drawn. The patient began to feel better a short time later and was discharged home. They were believed to have had a viral syndrome and were told to stop taking the antibiotics.

Evaluation and Treatment Decision

The patient was on an oral course of antimicrobials for a suspected UTI but was told to discontinue them after an ED visit.

T2Bacteria Panel Result

Positive for E.coli

Blood Cultures

No growth

Urine Cultures

No growth

Hospital course and decision making based on the T2Bacteria Panel result

After the patient was discharged, the T2Bacteria resulted and was positive for E.coli.  The patient was called but did not return the phone call until the next day.  Upon returning the call, they stated that they were feeling worse and were asked to return to the ED at that time.  The patient was started on IV ceftriaxone upon admission and transferred to the floor.  Blood cultures and urine cultures remained negative to date.

In this case, T2Bacteria picked up the E.coli infection from the suspected genitourinary infection, but it was never detected in blood or urine culture due to the previous administration of antimicrobials.  Approximately 36 hours later, the patient was discharged and sent home on oral antimicrobials to complete a standard course of therapy.

A patient was admitted with a two-day history of right lower quadrant pain, fever, and vomiting

Discussion

This case highlights the benefit of rapid species identification with the T2Bacteria Panel and the potential prevention of additional sequelae with a premature discharge from the ED.

Presentation

An elderly patient was admitted with a two-day history of right lower quadrant pain, fever, and vomiting.   A set of blood cultures and a T2Bacteria were drawn.

The patient received a fluid bolus and empiric antibiotics and started to stabilize, tolerating, orals, and was asking to go home.  The patient was discharged after being in the ED for approximately 6 hours and given oral antibiotics with a follow-up in 2 days with a primary care provider due to her suspicious urinalysis.  After the patient was discharged from the emergency department, the T2 resulted, approximately 4.5 hours after the draw.

Patient Selection Criteria

A septic patient presenting in the Emergency Department

Evaluation and Treatment Decision

Diagnosis

Suspected UTI

Empiric Therapy

The patient was started on ceftriaxone

T2Bacteria Panel Result

Positive for E. coli

Blood Culture Result

Positive for E. coli

Urine culture

Positive for E.coli

Hospital course and decision making based on the T2Bacteria Result

A rapid T2Bacteria positive for E. coli prompted the ED team to bring the patient back to the hospital for admission, which potentially prevented additional clinical complications.

Once the patient was re-admitted, they began to spike fevers. Approximately 12 hours after re-admission, the blood cultures turned positive.  A Gram-stain was done, and a Gram-negative was identified (about 14 hours after the T2 resulted).   At the same time, the urine culture turned positive, confirming the source as genitourinary.  The patient was administered IV ceftriaxone until discharge, approximately 2.5 days after admission.   Blood cultures were finalized approximately three days after the initial blood draw confirming the E.coli.  The patient was sent home on oral antibiotics to complete her course of therapy.

A 72 year-old-patient presented to the ER with a productive cough for three days, left flank pain, and intermittent nausea.

Discussion

This case highlights the benefits of using the high negative predictive value (NPV) of the T2Bacteria Panel for early de-escalation of therapy, mainly when using antimicrobial agents that can commonly cause acute kidney injury.

Presentation

A 72 year-old-patient presented to the ER with a productive cough for three days, left flank pain, and intermittent nausea.  Pertinent laboratory values included a temperature of 38.5 ^oC, WBC of 18.5, and a lactic acid of 5.4. The patient was hospitalized one month prior for nephrolithiasis with left ureteropelvic junction (UPJ) obstruction, complicated by ESBL E. coli bacteremia, and had a left ureteral stent placed at the time. A urinalysis, urine culture, blood culture, and T2Bacteria sample were drawn in the ER, and the patient was started on meropenem and vancomycin due to recent surgery and history of ESBL E.coli infection. The patient was transferred to the ICU.

Patient Selection Criteria

Septic patient with a fever presenting to the ED

Evaluation and Treatment Decision

Empiric Therapy

The patient was started on meropenem and vancomycin

T2Bacteria Panel Result

Positive for E.coli, negative for S. aureus, P. aeruginosa, K. pneumoniae, E. faecium

Blood culture Result

Positive for E.coli (ESBL positive)

Urine culture Result

Positive for E.coli (ESBL positive)

Hospital course and decision making based on the T2Bacteria Result

The positive T2Bacteria result for E. coli came back once the patient was transferred to the ICU. The team discontinued vancomycin based on the negative T2Bacteria result for S. aureus and continued the meropenem.  The high NPV (99.7%) of the T2Bacteria Panel provided crucial diagnostic information that allowed for more informed treatment decisions, specifically the de-escalation of the anti-staphylococcal agent.  Blood and urine cultures resulted on the third day of therapy, both positive for ESBL E. coli, sensitive to meropenem.  The patient was continued on meropenem and discharged to subacute rehab with a plan to continue meropenem until their scheduled ureteral stent removal and replacement.