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