Patient Case: 78-year-old male patient

University Hospital Augusta

Academic medical center in Augusta, GA

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Bug/Drug Mismatch Patient — Gram Positive

78 yo man admitted with fever, chills, nausea, vomiting, abdominal pain for 1 day. On exam he is ill appearing, vitals are stable, temp 38.5°C, physical exam unremarkable except RUQ pain, aortic stenosis murmur. RUQ pain consistent with acute cholecystitis. IAI suspected, and patient undergoes cholecystectomy

Empiric therapy Ertapenem
ID/AST method Accelerate PhenoTest® BC kit, in parallel with traditional methods (MALDI-TOF MS and VITEK®2)
ID result Enterococcus faecium
Therapy change Hospitalist and ASP pharmacist optimize to Zosyn, ID consulted. Switched to ampicillin
AST results Ampicillin (S), daptomycin (S), linezolid (S), vancomycin (S)
Time to AST results ∼7h post +BC with Accelerate PhenoTest® BC kit (versus traditional method of ∼99h with VITEK)
Patient outcome Discharged

Case Discussion

The infection-causing organism was not originally covered by empiric therapy. Antibiotic optimization possible after Accelerate ID result.

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