Table 2 Summary of cases for which rapid organism identification would have impacted clinical decision making
Case number | Gram stain day one | Clinical context | Antibiotics on day one | Organisms identified by direct MALDI-ToF on day one | Organisms identified from sub-culture day two | Antibiotic change on day two | Medical/surgical intervention |
|---|---|---|---|---|---|---|---|
1 | GNR | Pyelonephritis | Vancomycin and Gentamicin | S. maltophilia | S. maltophilia | Cefotaxime and Cotrimoxazole added | Neprostomy tube removed |
2 | GNR | Febrile neutropenia due to UTI | Piperacillin/Tazobactam and Gentamicin | E. coli | E. coli | Cefotaxime added. Gentamicin continued | – |
3 | GNR | Post-operative liver transplant infection | No antibiotics | Enterobacter cloacae complex | Enterobacter cloacae complex | Imipenem added | Interventions to sterilise line with antibiotic locks |
4 | GPR | Myonecrosis | Piperacillin/Tazobactam, Clindamycin and Vancomycin | C. septicum | C. septicum | High dose benzyl penicillin added clindamycin continued; tazocin and vancomycin ceased | Urgent re-exploration of leg as necrotising fasciitis |
5 | GPCSTR | Intra muscular abscess | Penicillin and Flucloxacillin | S.parasanguinis | S.parasanguinis | Penicillin continued Flucloxacillin stopped | MRI to rule out septic arthritis |
6 | GPCSTR | Meningitis | Cefotaxine, Gentamicin and Ampicillin | S. agalactiae | S. agalactiae | Benzylpenicillin added Cefotaxime, Gentamicin, Ampicillin ceased | – |
7 | GPCSTA | Congenital heart disease with fever | Vancomycin and Gentamicin | S. epidermidis | S. epidermidis | Vancomycin continued Gentamicin ceased | – |
8 | GPCSTA | Febrile neutropenia | Piperacillin/Tazobactam and Vancomycin | S. epidermidis | S. epidermidis | Vancomycin continued Piperacillin/Tazobactam ceased | CVL removed |
9 | GPCSTA | Primary immune deficiency with fever | Piperacillin/Tazobactam and Vancomycin | S. epidermidis | S. epidermidis | Piperacillin/Tazobactam and Vancomycin continued | CVL removed |
10 | GPCSTA | Acute bronchiolitis | Vancomycin | S. epidermidis | S. epidermidis | Vancomycin ceased as probable contamination | – |
11 | GPCSTR | Cerebral palsy | Vancomycin | S. mitis | S. mitis | Vancomycin ceased as probable contamination | – |