Bacteremic sepsis leads to higher mortality when adjusting for confounders with propensity score matching

Abstract

One can falsely assume that it is well known that bacteremia is associated with higher mortality in sepsis. Only a handful of studies specifically focus on the comparison of culture-negative and culture-positive sepsis with different conclusions depending on study design. The aim of this study was to describe outcome for critically ill patients with either culture-positive or -negative sepsis in a clinical review. We also aimed to identify subphenotypes of sepsis with culture status included as candidate clinical variables. Out of 784 patients treated in intensive care with a sepsis diagnosis, blood cultures were missing in 140 excluded patients and 95 excluded patients did not fulfill a sepsis diagnosis. Of 549 included patients, 295 (54%) had bacteremia, 90 (16%) were non-bacteremic but with relevant pathogens detected and in 164 (30%) no relevant pathogen was detected. After adjusting for confounders, 90-day mortality was higher in bacteremic patients, 47%, than in non-bacteremic patients, 36%, p = 0.04. We identified 8 subphenotypes, with different mortality rates, where pathogen detection in microbial samples were important for subphenotype distinction and outcome. In conclusion, bacteremic patients had higher mortality than their non-bacteremic counter-parts and bacteremia is more common in sepsis when studied in a clinical review. For reducing population heterogeneity and improve the outcome of trials and treatment for sepsis, distinction of subphenotypes might be useful and pathogen detection an important factor.

Bacteriological Profile in Septicaemic Patients with Elevated C-reactive Protein in Intensive Care Units at A Tertiary Care Hospital

“…Furthermore, the prevalence of culture positive sepsis reported from several ICU in South Asia ranged from 6 to 56%, 52.9% in this study was near comparable with the study by Lisa Mellhammar et al 18 having 54%, most likely is due to discrepancies in study design and terminology. 12, [14][15][16][17][18] In our study culture positivity was 52.9% among elevated CRP Patients similar to the study of Jyoti et al study who also got 49% with CRP elevated above 6mg/dl 12 n a study done by Abera Kumalo culture positivity was a 16% & even low as near 7% in recent study by Bajaj A et al 19 in may be because they did not take CRP positivity as adjunct criteria for selecting samples. 20 In our study, major positive samples were from IMCU (42.6%) similarly higher percentages are seen in other studies also, a study done by Calik Z had highest percentage with 81% of his samples were from IMCU.…”

“…21 Gram negative bacteria 33 (61.1%) organisms were isolated more compared to Gram positive cocci 17 (31.5%) in our study. Similarly GNB was most commonly isolated organisms in many studies evident in Bajaj et al 18 from southern India region (65%) & from northern India one study done by Surbhikhurana et al, a 4 years study showed a percentage variations from 78% to 85%. This is well known as Gram-negative bacilli produces endotoxins that kick start the septicemia.…”

Rationale for sequential extracorporeal therapy (SET) in sepsis

“…Pathogenemia refers to an infective agent measurable in the blood. For patients with sepsis, pathogenemia is associated with worse outcomes [ 15 , 16 ]. Furthermore, the pathogen load is directly linked to higher morbidity and mortality [ 17 – 19 ].…”

Defining Posttraumatic Sepsis for Population-Level Research

“…10 A recent study found that, among critically ill adults who met Sepsis-3 diagnostic criteria, those with bacteremia had proportionally higher mortality compared with those without bacteremia. 32 This finding may partially explain the relatively lower mortality observed with the automated clinical method compared with the NTDB because the automated clinical method incorporates cultures from different body tissues. Although the NTDB and the automated clinical method had similarly strong associations with chronic critical illness, only a few patients at high risk were identified by the NTDB.…”