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T2Bacteria for the Diagnosis of Culture-Negative Infective Endocarditis

Case study highlighting the detection of S. aureus bacteremia leading to diagnosis of infective endocarditis that was missed by culture

University of Louisville Health | Louisville, KY

Presentation

A 39-year-old female presented with right ankle cellulitis, abscess, and osteomyelitis.

Patient History

The patient had a recent incision and drainage on hospital day 7, and a consultation with the Bone & Joint Infections Disease team on hospital day 8.

The patient had a history of polysubstance abuse, anxiety, depression, and a motor vehicle accident (one year prior) with an external ankle fixation

Evaluation and Treatment Decision

  • On hospital day 1, blood cultures and T2Bacteria were ordered, and the patient was initiated on vancomycin and ceftriaxone.
  • T2Bacteria was positive for Staphylococcus aureus, but blood cultures showed no growth at 5 days.
    • Based on patient risk factors and the positive T2Bacteria result, therapy was narrowed to only vancomycin.
  • On hospital day 7, bone and joint cultures were taken, but did not grow.
  • The positive T2Bacteria result was used to direct resource utilization with a transesophageal echo (TEE) performed on hospital day 12.
    • 0.47 x 0.20 cm mobile echogenic density on mitral valve leaflet consistent with vegetation.
  • Cardiovascular (CV) surgery was consulted who recommended further CV surgery evaluation.

Learn More

To learn more about this case, watch the Learning Lounge presentation from IDWeek 2024
Watch Presentation

1. Ross, A. Pharmacists’ Perspective: Real-World T2Bacteria® Experience, IDWeek. 2024.

Faster Targeted Therapy with the T2Bacteria Detection of a Polymicrobial Infection

T2Bacteria case study highlighting the early detection of a polymicrobial infection

University of Louisville Health | Louisville, KY

Presentation

A 51-year-old male presented with acute decompensated heart failure.

Patient History

The patient had a history of intravenous (IV) drug use, hepatitis C, cirrhosis, and diabetes.

The patient also had urinary symptom complaints that began with admission, and the patient was on ceftriaxone (1 gram IV) for Escherichia coli from a previous urine culture.

Evaluation and Treatment Decision

  • On hospital day 4, the patient experienced a new septic event, and T2Bacteria and blood cultures were ordered.
  • Vancomycin was added and ceftriaxone was escalated to piperacillin/tazobactam.
  • ≈ 6 hours after the blood draw, T2Bacteria was positive for Escherichia coli and Staphylococcus aureus.
  • On hospital day 5, ≈19 hours after the blood draw, the blood culture was also positive for Staphylococcus aureus, but never grew Escherichia coli.
  • The patient was de-escalated from piperacillin/tazobactam to ceftriaxone to complete a 7-day course and continued vancomycin.

The identification of an additional Staphylococcus aureus infection allowed for directed therapy with the addition of vancomycin.

Learn More

To learn more about this case, watch the Learning Lounge from IDWeek 2024
Watch Presentation

1. Ross, A. Pharmacists’ Perspective: Real-World T2Bacteria® Experience, IDWeek. 2024.

Avoidance of Inappropriate De-escalation with T2Candida

Case study highlighting the rapid identification of Candida infection while cultures remained negative

Gulf Coast Medical Center, Lee Health | Fort Meyers, FL

 

Presentation

A 75-year-old female presenting with abdominal pain and hypotension.

Patient History

Hypertension, hyperlipidemia, type 2 Diabetes mellites, ovarian cancer with metastases, placement of a percutaneous endoscopic gastrostomy (PEG) tube, and total parental nutrition (TPN) dependent. 

The patient was recently discharged after a prolonged hospital stay (3 weeks) and underwent several GI surgeries, most recently a bowel resection for duodenal perforation as a result of tumor erosion.

Surgical oncology, Gastroenterology, and Infectious Diseases services were all consulted to manage the case.

Evaluation and Treatment Decision

  • Urinalysis was positive for many yeast on the admission workup
  • Blood and urine cultures and T2Candida were ordered by ID consultant
  • T2Candida was positive for Candida glabrata/krusei, while blood and urine cultures remained negative
  • The patient was initiated on Piperacillin/Tazobactam and Micafungin

The identification of Candida glabrata/krusei with the T2Candida Panel prevented the inappropriate de-escalation of antifungal therapy in a high-risk patient.

Learn More

To learn more about T2Candida and this case study, watch the webinar, Real World Experience with T2Candida at a Community Health System
Watch Webinar

1. Chandler, E. Real World Experience with T2Candida at a Community Health System (Webinar). 2024

Faster Time to Targeted Therapy with T2Bacteria

In both of these clinical case studies, T2Bacteria® identified the causative pathogen days sooner than blood culture and allowed for the earlier initiation of targeted therapy.1

Butler Health System | Butler, PA

Case 1
Age and Sex: 70-year-old male

Presentation: The patient presented with shortness of breath, hypothermia, hypertension and was admitted. The patient had no sepsis indicators and no action was taken for sepsis screening.

Vitals: T = 99.8; BP = 152/86; P = 70

Evaluation and Treatment

Day 0

• WBC = 23.2, MDW* = 23.05 lactic acid = 1.0,PCT = .32

• T2Bacteria Result: The T2Bacteria Panel was positive for Enterococcus faecium, and the patient was initiated on targeted therapy

Day 1

• Blood culture confirmed Enterococcus faecium.

T2Bacteria allowed for targeted therapy 20 hours faster than blood culture alone.

Case 2
Age and Sex: 67-year-old male

Presentation: The patient presented with altered mental status and hypotension, and was admitted. The patient had no sepsis indicators and no action was taken for sepsis screening.

Vitals: T not taken, BP= 62/44, P = 53

Evaluation and Treatment

Day 0

• WBC = 24.7, MDW* = 23.98, lactic acid = 1.0, PCT = 4.25

Day 1

• T2Bacteria Result: The T2Bacteria Panel was positive for Pseudomonas aeruginosa, and the patient was initiated on targeted therapy

Day 3

• Blood culture confirmed Pseudomonas aeruginosa.

T2Bacteria allowed for targeted therapy 37 hours faster than blood culture alone.

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*This institution uses an algorithm combining Monocyte Distribution Width (MDW) from Beckman Coulter and white blood count (WBC) metrics as an indicator to run T2Bacteria.

  1. Patterson, R., Katsaros, S., Industry Showcase, ASM 2023

Targeted Antibiotic Therapy in Endocarditis Case with T2Bacteria

PRESIDIO HOSPITAL  |  Caltanissetta, Italy1

A T2Bacteria result facilitated the diagnosis of infective endocarditis that led to the rapid initiation of targeted antibiotic therapy in a critically ill patient with prosthetic valve endocarditis. Fast species ID enabled targeted treatment 8 days before blood culture results were available.

Patient Presentation

The patient was admitted with fever, asthenia, myalgia, and a history of aortic valve replacement and diabetes. On the third day the patient had decompensation with hyperglycemia, hypokalemia, anuria, and hypotension refractory to fluids and vasopressors.

Evaluation and Treatment Decision

Day 3 
Complete system evaluation including chest X-ray, transthoracic echocardiogram, cultures (BAL, blood), T2Bacteria ordered, and broad-spectrum antibiotics administered (ciprofloxacin, daptomycin, linezolid)

WBC 15.2 103/uL, PCT 35.2 ug/L, T2Bacteria test positive for Staphylococcus aureus, positive Osler and Janeway lesions

Antibiotic therapy changed (vancomycin, rifampin, gentamicin) for suspected Staphylococcus aureus prosthetic valve endocarditis.

Day 6
Transthoracic echocardiogram positive for mobile vegetations

Day 11
Anaerobic blood culture positive for Staphylococcus aureus

1. Federico, A., Sicily Medical Education Forum. 2022 

Detection of Polymicrobial Infection in Critically Ill COVID-19 Patient

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.

Download Case Study

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Popular Posts

According to the CDC, of the 154 million prescriptions for antibiotics written in doctors’ offices and emergency departments each year, 30% are unnecessary.12

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T2 BIOSYSTEMS OVERVIEW

T2 Biosystems, an emerging leader in the field of in vitro diagnostics, is dedicated to saving lives and reducing the cost of healthcare by empowering clinicians to effectively treat patients faster than ever before. T2 Biosystems is focused on addressing critical unmet needs in healthcare starting with sepsis, one of the deadliest and most expensive conditions in hospitals today.

The T2Dx Instrument, the T2Bacteria and T2Candida Panels have received marketing authorization from the U.S. Food and Drug Administration. All other T2 Biosystems products are considered investigational and for research use only.

T2 Biosystems®, T2MR®, T2Bacteria®, T2Candida®, T2Resistance® and T2Dx® are registered trademarks of T2 Biosystems, Inc. “T2Biosystems” and the T2 Biosystems, Inc. logo design are registered trademarks or trademarks of T2Biosystems, Inc. All software and documentation is subject to T2 Biosystems, Inc. copyrights. All rights reserved. T2Direct Diagnostics™, T2HemoStat™, T2Plex™, T2Cauris™, T2Lyme™ and T2SARS-CoV-2™ are trademarks of T2 Biosystems, Inc.

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