52-year-old male, currently undergoing hemodialysis three times weekly with a complicated medical history.

Discussion

This case highlights the benefit of the T2Bacteria Panel’s rapid species identification, allowing for the rapid initiation of appropriate antimicrobial therapy and resulting in clinical improvement.

Presentation

The patient was a 52-year-old male, currently undergoing hemodialysis three times weekly with a complicated medical history, including diabetes, hypertension, lung cancer, chronic kidney disease. While at dialysis, he experienced confusion and hypotension. The physician was notified, and the patient was transferred to the emergency department. In the emergency department, he was believed to be dehydrated secondary to too much fluid removed during dialysis. He received fluid resuscitation, and blood cultures, and T2Bacteria were obtained. Empiric antibiotics were not initiated.

Evaluation and Treatment Decision

Vitals

Temp- 37.5, HR- 89BPM, BP- 90/60

T2 Result

Positive for E.coli.  Negative for all other bacterial targets. (results available at 6 hours after initial presentation)

Blood Culture Result

no growth reported

Decision making based on T2Candida Result

The patient’s therapy was adjusted based on the T2Bacteria result. The patient did not improve after fluid resuscitation and was being transferred to the ICU at the time of T2Bacteria result due to persistent hypotension. Orders were initially written for vancomycin and cefepime, but the T2Bacteria results were received prior to administration, and therapy was changed to ceftriaxone (targeted therapy for E.coli infection).

A 55-year-old male presented to the hospital from an outside facility with sepsis secondary to pyelonephritis.

Discussion

This case highlights not only T2Bacteria’s ability of rapid identification but also the capability to detect the causative organism in the presence of antibiotics. The patient, in this case, received a dose of ceftriaxone and azithromycin before the blood cultures and T2Bacteria were drawn. Bloodstream infection was missed by blood culture but was identified with rapid detection provided by the T2Bacteria Panel. The use of T2Bacteria, in this case, allowed an early confirmation of effective antibiotic therapy.

Presentation

A 55-year-old male presented to the hospital from an outside facility with sepsis secondary to pyelonephritis. Before transfer, the patient received one dose of ceftriaxone and azithromycin. He was subsequently admitted to ICU with septic shock and acute renal failure, which required the initiation of continuous renal replacement therapy. Blood cultures, urine cultures, and T2Bacteria sepsis panel were obtained.

Patient Selection Criteria

Critically ill patients with sepsis/septic shock and/or elevated procalcitonin

Evaluation and Treatment Decision

Diagnosis

Septic shock secondary to pyelonephritis

T2Bacteria Result

Positive for E. coli

Blood Culture Result

No growth

Urine Culture Result

E. Coli

Empiric Therapy

Cefepime

Decision making based on T2Bacteria Result

A rapid T2Bacteria result allowed for early diagnosis of E. coli bacteremia and the confirmation of effective empiric antibiotic therapy. T2Bacteria detected E. coli directly from whole blood approximately 4 hours after the patient presented to the hospital. The positive T2Bacteria result was obtained hours before the blood cultures were even able to be sent to an off-site core lab to be processed, which ultimately did not grow.

An 81-year-old patient with a complicated medical history was admitted to the hospital for a tracheoesophageal fistula repair.

Discussion

This case highlights the benefit of the T2Bacteria Panel’s turnaround time for species identification. Tigecycline has been associated with high rates of gastrointestinal adverse events such as nausea and vomiting and does not provide adequate coverage of P. aeruginosa. The rapid result provided by T2Bacteria allowed for discontinuation of Tigecycline after only one dose. Additionally, amikacin was added as an antimicrobial known to be effective against P. aeruginosa based on the institution’s antibiogram.

Presentation

An 81-year-old patient with a complicated medical history including diabetes, dysphagia, Parkinson’s Disease, and a history of multiple hospitalizations over the last six months was admitted to the hospital for a tracheoesophageal fistula repair. The patient developed signs and symptoms of pneumonia several days post-operatively. T2Bacteria, blood, sputum, and tracheostomy cultures were obtained after the patient was started on ceftolozane/tazobactam and tigecycline empirically.

Evaluation and Treatment Decision

Vitals

Temp- 36.5, HR- 69BPM

Available labs

WBC- 21.7K CRP- 22.2 mg/dl, PCT – 2.48ng/mL.

T2Bacteria Result

Positive for P. aeruginosa and negative for all other bacterial targets (results available at 5h2min)

Blood Culture Result

no growth reported

Other cultures

Tracheostomy Exit Site: P. aeruginosa, C. albicans; Rectal swab: E. faecium, P. aeruginosa

Decision Making Based on T2Bacteria Results

The patient’s therapy was adjusted based on the T2Bacteria Panel result. Tigecycline was discontinued and the patient was started on amikacin in addition to ceftolozane/tazobactam in order to provide effective coverage for P. aeruginosa.

The patient presented to the emergency department with flu-like symptoms

Discussion

This case highlights the ability of the T2Bacteria^® Panel to provide rapid species identification of causative pathogens in sepsis cases. It examines clinical challenges with current methods, including delayed blood culture growth, as well as polymicrobial infections. A rapid T2Bacteria result could have allowed for more informed treatment decisions, including earlier initiation of antibiotic therapy and earlier admission to the hospital.

Presentation

The patient presented to the emergency department with flu-like symptoms, but at the time, clinical status and workup did not warrant admission. The patient continued to decline and re-presented to the emergency department approximately 18 hours later with shortness of breath. While in the emergency department during the second visit, the blood cultures that were obtained during the earlier visit resulted positive with gram-negative rods, and the prescriber was notified. The patient was subsequently admitted, and empiric antibiotics were initiated.

Patient Selection Criteria

Procalcitonin 10.21

Evaluation and Treatment Decision

Diagnosis

bacteremia

T2Bacteria Result

(sample obtained during initial ED visit): Positive for Pseudomonas aeruginosa and E. coli

Blood culture #1 Result

(obtained during initial ED visit): Pseudomonas aeruginosa and Serratia marcescens
(time to culture positivity: 20.5 hours; time to species ID: ~2.5 days for P. aeruginosa and ~5 days for S. marcescens).

*Note: Verigene assay was performed after detection of the growth of gram-negative rod on the culture. It was positive for the detection of Klebsiella oxytoca only and not the pathogens that grew in blood culture.

Blood culture #2 Result

(obtained during second ED visit): E. coli
(time to culture positivity: 24 hours; time to species ID: ~1.5 days)

Empiric Therapy

meropenem

Decision making based on T2Bacteria Result

Note: T2Bacteria results were not reported as this case was part of an observational study.

The blood cultures that were obtained from the patient upon initial presentation had delayed the growth of gram-negative rods, which were found 22 hours later. The patient was discharged from the emergency department prior to blood culture resulting in positive for growth. The patient continued to decline and re-presented to the emergency room, requiring subsequent admission to the hospital.

Had the T2Bacteria test been performed, and the result been reported immediately after collection, the patient could have potentially avoided the premature discharge from the emergency department and earlier initiation of effective antibiotic therapy.

The patient was admitted to the hospital with COPD exacerbation and respiratory distress.

Discussion

This case highlights how the T2Bacteria Panel can guide treatment by rapidly identifying the causative pathogen in sepsis cases that are missed by blood cultures. Rapid detection of bloodstream infection by T2Bacteria could have allowed for the escalation of effective antibiotic therapy, potentially leading to the prevention of further clinical deterioration.

Presentation

The patient was admitted to the hospital with COPD exacerbation and respiratory distress. They were subsequently transferred to the ICU with respiratory failure requiring intubation and renal failure. Antibiotics were initiated at the time of admission, but no cultures were obtained. The patient continued to have fever and leukocytosis and on day 5 of hospitalization, blood cultures and T2Bacteria Panel were obtained.

Patient Selection Criteria

Patients with sepsis presenting to ICU from the Emergency Department

Evaluation and Treatment Decision

Diagnosis

fever of unknown origin, possible bloodstream infection

T2Bacteria Result

Positive for P. aeruginosa

Blood culture Result

no growth

Empiric Therapy

Ceftriaxone

Decision making based on T2Bacteria Result

T2Bacteria and blood cultures were obtained after 5 days of antibiotic therapy for an infectious workup for persistent leukocytosis and fever of unknown origin. Because this case was part of an observational study, T2Bacteria results were not reported.  Had T2Bacteria been performed and results reported immediately after collection, it may have prompted the physician to add targeted therapy and avoid clinical deterioration.

The patient presented to the Emergency Department with acute respiratory failure and was admitted to the ICU with orders for blood cultures, T2Bacteria, and empiric antibiotics.

Discussion

In this case, rapid detection of bloodstream infection by the T2Bacteria Panel could have allowed for more informed treatment decisions, including the continuation of effective antibiotic therapy, which may have led to the prevention of clinical deterioration.

Presentation

The patient presented to the Emergency Department with acute respiratory failure and was admitted to the ICU with orders for blood cultures, T2Bacteria, and empiric antibiotics.

Patient Selection Criteria

Patients with sepsis presenting to ICU from the Emergency Department

Evaluation and Treatment Decision

Diagnosis

Possible pneumonia

T2Bacteria Result

Positive for P. aeruginosa

Blood culture Result

No growth

Respiratory Culture #1 Result

Enterobacter (resistant to cefepime, susceptible to levofloxacin)

Respiratory Culture #2 Result

P. aeuriginosa (intermediate resistance to levofloxacin, susceptible to cefepime and imipenem)

Empiric Therapy

cefepime, vancomycin

Decision making based on T2Bacteria Result

T2Bacteria and blood cultures were obtained for an infectious workup at the time of admission (T2Bacteria results were not reported, as this case was part of an observational study).

Empiric antibiotics included cefepime and vancomycin. Antibiotic therapy was changed to levofloxacin on day 5 of hospitalization to target the Enterobacter species, which was identified in the first respiratory culture. The patient continued to decline, and a second respiratory culture was obtained on day 10 of hospitalization, which grew P. aeuriginosa with intermediate resistance to levofloxacin. Antibiotics were then escalated to meropenem to treat both respiratory pathogens that were isolated in cultures.

Had the institution known of the rapid T2Bacteria result of P. aeuriginosa, the physician may not have changed therapy to levofloxacin considering the patient’s risk factors and local resistance patterns. Clinical deterioration could potentially have been avoided.