| Patient . | KT Result . | Other SMT Result . | Clinical Diagnosis . | Antibiotics Received (all) . | Case Details . |
|---|---|---|---|---|---|
| 1 | Negative | Negative, no tooth cultures | Dental infection | PIP-TAZ; AMOX-CLAV; ERT | Underwent tooth extraction; periodontal disease and “lucencies” on imaging |
| 2 | Negative | Tooth abscess culture: Prevotella spp | Dental abscess | PIP-TAZ; VORI | Underwent tooth extraction |
| 3 | Negative | Negative | Facial cellulitis | PIP-TAZ; VANC | Jaw pain, swelling, tenderness of left mandibular region—swelling on CT, improved with antimicrobials |
| 4 | Negative | Negative | RLE cellulitis | CEF; VANC | Purpura and DVT on the same leg |
| 5 | Negative | Negative | Sepsis of unclear etiology | CEF; VANC; VORI; PIP-TAZ; ACV | Persistent fever on day 3 developed shock. Noted hemoglobin drop (7 to 4.8 g/dL); no identified source of bleeding; improvement within 24 hours following steroids, PRBC, and broad antimicrobials |
| 6 | Negative | Negative, no fungal cultures, Asp GM and 1,3 BDG negative | Fungal pneumonia | PIP-TAZ; MERO; VORI | CT chest with 7-mm nodule and small areas of GGO |
| 7 | Rhizopus spp at T2, T3 | BAL: 6 colonies of Aspergillus niger Brain abscess: fungal cultures, fungal sequencing negative Brain histopathology: fungal forms consistent with Rhizopus spp. | Necrotizing fungal pneumonia and brain abscess | CEF; PIP-TAZ; VORI; L-AMB | CT chest: right lower lobe consolidation with surrounding GGO, VORI initiated On day 10, growth of A niger CT chest day 12: progressive cavitating pneumonia, changed to L-AMB. - Day 28; MRI brain: abscess - Day 30: Fungal hyphae identified on tissue |
| Patient . | KT Result . | Other SMT Result . | Clinical Diagnosis . | Antibiotics Received (all) . | Case Details . |
|---|---|---|---|---|---|
| 1 | Negative | Negative, no tooth cultures | Dental infection | PIP-TAZ; AMOX-CLAV; ERT | Underwent tooth extraction; periodontal disease and “lucencies” on imaging |
| 2 | Negative | Tooth abscess culture: Prevotella spp | Dental abscess | PIP-TAZ; VORI | Underwent tooth extraction |
| 3 | Negative | Negative | Facial cellulitis | PIP-TAZ; VANC | Jaw pain, swelling, tenderness of left mandibular region—swelling on CT, improved with antimicrobials |
| 4 | Negative | Negative | RLE cellulitis | CEF; VANC | Purpura and DVT on the same leg |
| 5 | Negative | Negative | Sepsis of unclear etiology | CEF; VANC; VORI; PIP-TAZ; ACV | Persistent fever on day 3 developed shock. Noted hemoglobin drop (7 to 4.8 g/dL); no identified source of bleeding; improvement within 24 hours following steroids, PRBC, and broad antimicrobials |
| 6 | Negative | Negative, no fungal cultures, Asp GM and 1,3 BDG negative | Fungal pneumonia | PIP-TAZ; MERO; VORI | CT chest with 7-mm nodule and small areas of GGO |
| 7 | Rhizopus spp at T2, T3 | BAL: 6 colonies of Aspergillus niger Brain abscess: fungal cultures, fungal sequencing negative Brain histopathology: fungal forms consistent with Rhizopus spp. | Necrotizing fungal pneumonia and brain abscess | CEF; PIP-TAZ; VORI; L-AMB | CT chest: right lower lobe consolidation with surrounding GGO, VORI initiated On day 10, growth of A niger CT chest day 12: progressive cavitating pneumonia, changed to L-AMB. - Day 28; MRI brain: abscess - Day 30: Fungal hyphae identified on tissue |
Abbreviations: 1,3 BDG, 1,3 beta-D-glucan; ACV, acyclovir; AMOX-CLAV, amoxicillin-clavulanic; Asp GM, aspergillus galactomannan; CEF, cefepime; CT, computed tomography; ERT, ertapenem; GGO, ground-glass opacities; KT, Karius test; L-AMB, liposomal amphotericin; MERO, meropenem; MRI, magnetic resonance imaging; PIP-TAZ, piperacillin-tazobactam; PRBC, packed red blood cell; RLE, right lower extremity; SMT, standard microbiological testing; VANC, vancomycin; Vori, voriconazole.
| Patient . | KT Result . | Other SMT Result . | Clinical Diagnosis . | Antibiotics Received (all) . | Case Details . |
|---|---|---|---|---|---|
| 1 | Negative | Negative, no tooth cultures | Dental infection | PIP-TAZ; AMOX-CLAV; ERT | Underwent tooth extraction; periodontal disease and “lucencies” on imaging |
| 2 | Negative | Tooth abscess culture: Prevotella spp | Dental abscess | PIP-TAZ; VORI | Underwent tooth extraction |
| 3 | Negative | Negative | Facial cellulitis | PIP-TAZ; VANC | Jaw pain, swelling, tenderness of left mandibular region—swelling on CT, improved with antimicrobials |
| 4 | Negative | Negative | RLE cellulitis | CEF; VANC | Purpura and DVT on the same leg |
| 5 | Negative | Negative | Sepsis of unclear etiology | CEF; VANC; VORI; PIP-TAZ; ACV | Persistent fever on day 3 developed shock. Noted hemoglobin drop (7 to 4.8 g/dL); no identified source of bleeding; improvement within 24 hours following steroids, PRBC, and broad antimicrobials |
| 6 | Negative | Negative, no fungal cultures, Asp GM and 1,3 BDG negative | Fungal pneumonia | PIP-TAZ; MERO; VORI | CT chest with 7-mm nodule and small areas of GGO |
| 7 | Rhizopus spp at T2, T3 | BAL: 6 colonies of Aspergillus niger Brain abscess: fungal cultures, fungal sequencing negative Brain histopathology: fungal forms consistent with Rhizopus spp. | Necrotizing fungal pneumonia and brain abscess | CEF; PIP-TAZ; VORI; L-AMB | CT chest: right lower lobe consolidation with surrounding GGO, VORI initiated On day 10, growth of A niger CT chest day 12: progressive cavitating pneumonia, changed to L-AMB. - Day 28; MRI brain: abscess - Day 30: Fungal hyphae identified on tissue |
| Patient . | KT Result . | Other SMT Result . | Clinical Diagnosis . | Antibiotics Received (all) . | Case Details . |
|---|---|---|---|---|---|
| 1 | Negative | Negative, no tooth cultures | Dental infection | PIP-TAZ; AMOX-CLAV; ERT | Underwent tooth extraction; periodontal disease and “lucencies” on imaging |
| 2 | Negative | Tooth abscess culture: Prevotella spp | Dental abscess | PIP-TAZ; VORI | Underwent tooth extraction |
| 3 | Negative | Negative | Facial cellulitis | PIP-TAZ; VANC | Jaw pain, swelling, tenderness of left mandibular region—swelling on CT, improved with antimicrobials |
| 4 | Negative | Negative | RLE cellulitis | CEF; VANC | Purpura and DVT on the same leg |
| 5 | Negative | Negative | Sepsis of unclear etiology | CEF; VANC; VORI; PIP-TAZ; ACV | Persistent fever on day 3 developed shock. Noted hemoglobin drop (7 to 4.8 g/dL); no identified source of bleeding; improvement within 24 hours following steroids, PRBC, and broad antimicrobials |
| 6 | Negative | Negative, no fungal cultures, Asp GM and 1,3 BDG negative | Fungal pneumonia | PIP-TAZ; MERO; VORI | CT chest with 7-mm nodule and small areas of GGO |
| 7 | Rhizopus spp at T2, T3 | BAL: 6 colonies of Aspergillus niger Brain abscess: fungal cultures, fungal sequencing negative Brain histopathology: fungal forms consistent with Rhizopus spp. | Necrotizing fungal pneumonia and brain abscess | CEF; PIP-TAZ; VORI; L-AMB | CT chest: right lower lobe consolidation with surrounding GGO, VORI initiated On day 10, growth of A niger CT chest day 12: progressive cavitating pneumonia, changed to L-AMB. - Day 28; MRI brain: abscess - Day 30: Fungal hyphae identified on tissue |
Abbreviations: 1,3 BDG, 1,3 beta-D-glucan; ACV, acyclovir; AMOX-CLAV, amoxicillin-clavulanic; Asp GM, aspergillus galactomannan; CEF, cefepime; CT, computed tomography; ERT, ertapenem; GGO, ground-glass opacities; KT, Karius test; L-AMB, liposomal amphotericin; MERO, meropenem; MRI, magnetic resonance imaging; PIP-TAZ, piperacillin-tazobactam; PRBC, packed red blood cell; RLE, right lower extremity; SMT, standard microbiological testing; VANC, vancomycin; Vori, voriconazole.
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