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Table 2 Summary of cases for which rapid organism identification would have impacted clinical decision making

From: Rapid direct identification of positive paediatric blood cultures by MALDI-TOF MS technology and its clinical impact in the paediatric hospital setting

Case numberGram stain day oneClinical contextAntibiotics on day oneOrganisms identified by direct MALDI-ToF on day oneOrganisms identified from sub-culture day twoAntibiotic change on day twoMedical/surgical intervention
1GNRPyelonephritisVancomycin and GentamicinS. maltophiliaS. maltophiliaCefotaxime and Cotrimoxazole addedNeprostomy tube removed
2GNRFebrile neutropenia due to UTIPiperacillin/Tazobactam and GentamicinE. coliE. coliCefotaxime added. Gentamicin continued
3GNRPost-operative liver transplant infectionNo antibioticsEnterobacter cloacae complexEnterobacter cloacae complexImipenem addedInterventions to sterilise line with antibiotic locks
4GPRMyonecrosisPiperacillin/Tazobactam, Clindamycin and VancomycinC. septicumC. septicumHigh dose benzyl penicillin added clindamycin continued; tazocin and vancomycin ceasedUrgent re-exploration of leg as necrotising fasciitis
5GPCSTRIntra muscular abscessPenicillin and FlucloxacillinS.parasanguinisS.parasanguinisPenicillin continued Flucloxacillin stoppedMRI to rule out septic arthritis
6GPCSTRMeningitisCefotaxine, Gentamicin and AmpicillinS. agalactiaeS. agalactiaeBenzylpenicillin added
Cefotaxime, Gentamicin, Ampicillin ceased
7GPCSTACongenital heart disease with feverVancomycin and GentamicinS. epidermidisS. epidermidisVancomycin continued
Gentamicin ceased
8GPCSTAFebrile neutropeniaPiperacillin/Tazobactam and VancomycinS. epidermidisS. epidermidisVancomycin continued
Piperacillin/Tazobactam ceased
CVL removed
9GPCSTAPrimary immune deficiency with feverPiperacillin/Tazobactam and VancomycinS. epidermidisS. epidermidisPiperacillin/Tazobactam and Vancomycin continuedCVL removed
10GPCSTAAcute bronchiolitisVancomycinS. epidermidisS. epidermidisVancomycin ceased as probable contamination
11GPCSTRCerebral palsyVancomycinS. mitisS. mitisVancomycin ceased as probable contamination
  1. MALDI-TOF matrix assisted laser desorption ionization-time of flight, GNR Gram negative rods, GPR Gram positive rods, GPCSTR Gram positive Staphylococci, GPCSTA Gram positive Streptococci, CVL central venous line, UTI urinary tract infection