Characteristics and clinical outcomes of culture-negative and culture-positive septic shock: a single-center retrospective cohort study
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.
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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.
Additional file 2: Supplementary Table 1. Frequency of the sub-species of the isolated bacteria.
Additional file 3: Supplementary Table 2. Baseline characteristics of septic shock according to the culture results
Additional file 4: Supplementary Table 3. Univariate and multivariate analysis for predicting mechanical ventilator requirements.
Additional file 5: Supplementary Table 4. In-hospital mortality according to sites of infection among patients with culture-negative septic shock.
Posted 23 Dec, 2020
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Received 16 Nov, 2020
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On 09 Nov, 2020
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On 08 Nov, 2020
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On 05 Oct, 2020
On 05 Oct, 2020
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On 04 Oct, 2020
Received 16 Sep, 2020
On 16 Sep, 2020
On 08 Sep, 2020
On 05 Sep, 2020
Received 07 Aug, 2020
Invitations sent on 30 Jul, 2020
On 30 Jul, 2020
On 23 Jul, 2020
On 22 Jul, 2020
On 22 Jul, 2020
On 20 Jul, 2020
Characteristics and clinical outcomes of culture-negative and culture-positive septic shock: a single-center retrospective cohort study
Posted 23 Dec, 2020
On 06 Jan, 2021
On 30 Nov, 2020
On 29 Nov, 2020
On 29 Nov, 2020
On 29 Nov, 2020
On 21 Nov, 2020
Received 16 Nov, 2020
Invitations sent on 09 Nov, 2020
On 09 Nov, 2020
On 08 Nov, 2020
On 08 Nov, 2020
On 08 Nov, 2020
On 29 Oct, 2020
Received 11 Oct, 2020
On 05 Oct, 2020
Invitations sent on 05 Oct, 2020
On 05 Oct, 2020
On 05 Oct, 2020
On 04 Oct, 2020
On 04 Oct, 2020
Received 16 Sep, 2020
On 16 Sep, 2020
On 08 Sep, 2020
On 05 Sep, 2020
Received 07 Aug, 2020
Invitations sent on 30 Jul, 2020
On 30 Jul, 2020
On 23 Jul, 2020
On 22 Jul, 2020
On 22 Jul, 2020
On 20 Jul, 2020
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.
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