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Characteristics and clinical outcomes of culture-negative and culture-positive septic shock: a single-center retrospective cohort study
Won Young Kim
Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center
Corresponding Author
ORCiD: https://orcid.org/0000-0002-6904-5966
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at Critical Care.
Background: We evaluated the characteristics and outcomes of culture-negative versus culture-positive septic shock.
Methods: We performed a retrospective observational study of data from a prospective registry from 2014 to 2018. A total of 2,499 adult patients with septic shock were enrolled. The primary outcome was 90-day mortality, and the secondary outcomes were the length of hospital stay, a requirement for mechanical ventilation or renal replacement therapy, and in-hospital mortality.
Results: Of 1,718 patients with septic shock, 1,012 (58.9%) patients were culture-positive (blood 803, urine 302, sputum 102, others 204) and the median pathogen detection time was 9.5 hours (aerobic 10.2 hours and anaerobic 9.0 hours). The most common site of culture-positive infection was the hepatobiliary tract (39.5%), while for the culture-negative it was the lower respiratory tract (38.2%). The culture-negative group had a lower mean body temperature (37.3 vs 37.7 ℃), lactate (2.5 vs. 3.2 mmol/L), C-reactive protein (11.1 vs 11.9 mg/dL), and sequential organ failure assessment score (7.0 vs. 8.0) than that of the culture-positive group. However, 90-day mortality between the groups was not significantly different (32.7 vs 32.2%, p=0.83), and the other clinical outcomes also did not differ significantly. Moreover, a shorter culture detection time was correlated with a higher sequential organ failure assessment score but not with mortality.
Conclusion: Patients with septic shock are frequently culture-negative, especially in cases where the infection focus is in the lower respiratory tract. Although culture-negative was associated with a degree of organ dysfunction, it was not an independent predictor of death.
Keywords
sepsis, septic shock, mortality, culture, time to blood culture positivity
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This is a list of supplementary files associated with this preprint. Click to download.
- Additionalfile1.pdf
Additional file 1: Supplementary Figure 1. Septic shock registry of the study population. Emergency medicine (EM) physicians on duty recognized the patients with presumed septic shock consecutively. They resuscitated patients and enrolled in the registry with informed consent. All of the data were reviewed by the well-trained EM staff who majored in critical care and decided to final inclusion. After excluding septic shock-mimic cases, EM physicians collected numerous variables, including demographic data, laboratory data, radiologic results, treatment-related parameters, and clinical outcomes. For the secondary analysis, investigators who involved this study extracted additional data, such as culture results, and time-to-positivity.
- Additionalfile2.pdf
Additional file 2: Supplementary Table 1. Frequency of the sub-species of the isolated bacteria.
- Additionalfile3.pdf
Additional file 3: Supplementary Table 2. Baseline characteristics of septic shock according to the culture results
- Additionalfile4.pdf
Additional file 4: Supplementary Table 3. Univariate and multivariate analysis for predicting mechanical ventilator requirements.
- Additionalfile5..pdf
Additional file 5: Supplementary Table 4. In-hospital mortality according to sites of infection among patients with culture-negative septic shock.
- RECORDChecklist.pdf
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CURRENT STATUS: Published
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Posted 23 Dec, 2020
Published
On 06 Jan, 2021
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Editorial decision: Accept
On 30 Nov, 2020
Editor assigned
On 29 Nov, 2020
Submission checks complete
On 29 Nov, 2020
Editor invited
On 29 Nov, 2020
No comments provided
Editorial decision: Minor revision
On 21 Nov, 2020
Review #1 received
Received 16 Nov, 2020
Reviewers invited
Invitations sent on 09 Nov, 2020
Reviewer #1 agreed
On 09 Nov, 2020
Editor assigned
On 08 Nov, 2020
Submission checks complete
On 08 Nov, 2020
Editor invited
On 08 Nov, 2020
No comments provided
Editorial decision: Major revision
On 29 Oct, 2020
Review #1 received
Received 11 Oct, 2020
Editor assigned
On 05 Oct, 2020
Reviewers invited
Invitations sent on 05 Oct, 2020
Reviewer #1 agreed
On 05 Oct, 2020
Reviewer #2 agreed
On 05 Oct, 2020
Submission checks complete
On 04 Oct, 2020
Editor invited
On 04 Oct, 2020
No comments provided
Review #2 received
Received 16 Sep, 2020
Editorial decision: Major revision
On 16 Sep, 2020
Reviewer #3 agreed
On 08 Sep, 2020
Reviewer #2 agreed
On 05 Sep, 2020
Review #1 received
Received 07 Aug, 2020
Reviewers invited
Invitations sent on 30 Jul, 2020
Reviewer #1 agreed
On 30 Jul, 2020
Editor assigned
On 23 Jul, 2020
Submission checks complete
On 22 Jul, 2020
Editor invited
On 22 Jul, 2020
First submitted
On 20 Jul, 2020
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Subject Areas
Critical Care & Emergency Medicine
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This preprint is under consideration at Critical Care. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Characteristics and clinical outcomes of culture-negative and culture-positive septic shock: a single-center retrospective cohort study
Won Young Kim
Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center
Corresponding Author
ORCiD: https://orcid.org/0000-0002-6904-5966
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 4
Posted 23 Dec, 2020
Published
On 06 Jan, 2021
No community comments so far
Editorial decision: Accept
On 30 Nov, 2020
Editor assigned
On 29 Nov, 2020
Submission checks complete
On 29 Nov, 2020
Editor invited
On 29 Nov, 2020
No comments provided
Editorial decision: Minor revision
On 21 Nov, 2020
Review #1 received
Received 16 Nov, 2020
Reviewers invited
Invitations sent on 09 Nov, 2020
Reviewer #1 agreed
On 09 Nov, 2020
Editor assigned
On 08 Nov, 2020
Submission checks complete
On 08 Nov, 2020
Editor invited
On 08 Nov, 2020
No comments provided
Editorial decision: Major revision
On 29 Oct, 2020
Review #1 received
Received 11 Oct, 2020
Editor assigned
On 05 Oct, 2020
Reviewers invited
Invitations sent on 05 Oct, 2020
Reviewer #1 agreed
On 05 Oct, 2020
Reviewer #2 agreed
On 05 Oct, 2020
Submission checks complete
On 04 Oct, 2020
Editor invited
On 04 Oct, 2020
No comments provided
Review #2 received
Received 16 Sep, 2020
Editorial decision: Major revision
On 16 Sep, 2020
Reviewer #3 agreed
On 08 Sep, 2020
Reviewer #2 agreed
On 05 Sep, 2020
Review #1 received
Received 07 Aug, 2020
Reviewers invited
Invitations sent on 30 Jul, 2020
Reviewer #1 agreed
On 30 Jul, 2020
Editor assigned
On 23 Jul, 2020
Submission checks complete
On 22 Jul, 2020
Editor invited
On 22 Jul, 2020
First submitted
On 20 Jul, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Critical Care & Emergency Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at Critical Care.
Background: We evaluated the characteristics and outcomes of culture-negative versus culture-positive septic shock.
Methods: We performed a retrospective observational study of data from a prospective registry from 2014 to 2018. A total of 2,499 adult patients with septic shock were enrolled. The primary outcome was 90-day mortality, and the secondary outcomes were the length of hospital stay, a requirement for mechanical ventilation or renal replacement therapy, and in-hospital mortality.
Results: Of 1,718 patients with septic shock, 1,012 (58.9%) patients were culture-positive (blood 803, urine 302, sputum 102, others 204) and the median pathogen detection time was 9.5 hours (aerobic 10.2 hours and anaerobic 9.0 hours). The most common site of culture-positive infection was the hepatobiliary tract (39.5%), while for the culture-negative it was the lower respiratory tract (38.2%). The culture-negative group had a lower mean body temperature (37.3 vs 37.7 ℃), lactate (2.5 vs. 3.2 mmol/L), C-reactive protein (11.1 vs 11.9 mg/dL), and sequential organ failure assessment score (7.0 vs. 8.0) than that of the culture-positive group. However, 90-day mortality between the groups was not significantly different (32.7 vs 32.2%, p=0.83), and the other clinical outcomes also did not differ significantly. Moreover, a shorter culture detection time was correlated with a higher sequential organ failure assessment score but not with mortality.
Conclusion: Patients with septic shock are frequently culture-negative, especially in cases where the infection focus is in the lower respiratory tract. Although culture-negative was associated with a degree of organ dysfunction, it was not an independent predictor of death.
Figure 1
Figure 2
Figure 3
Figure 4