Culture-Negative Severe Sepsis

Gupta, Shipra; Sakhuja, Ankit; Kumar, Gagan; McGrath, Eric; Nanchal, Rahul; Kashani, Kianoush

doi:10.1016/j.chest.2016.08.1460

Cited by 159 publications

(79 citation statements)

References 23 publications

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“…This study found that negative culture results were quite common in septic shock patients, which is supported by the ndings of a recent retrospective study using nationwide data covering ten years that revealed that the incidence of culture-negative status among patients with severe sepsis was increasing annually by about 28% [13]. The reasons for the continuous increment of culture-negativity could be multifactorial.…”

Section: Discussionsupporting

confidence: 72%

“…Our study also found that CNSS behaved quite similarly to CPSS. Looking at the literature, Gupta et al reported that severe sepsis cases with undetected cultures had more comorbidities and organ failures, and it was an independent predictor of death after adjusting for confounders (OR 1.75 [95% CI 1.72-1.77]) [13]. On the other hand, two retrospective studies found that culture-negative and culture-positive severe sepsis had similar outcomes after adjusting for confounders, such as demographics, site of infection, and appropriate antibiotics [18,19].…”

Section: Discussionmentioning

confidence: 99%

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Culture-negative and culture-positive septic shock: characteristics and clinical outcomes

Kim

2020

Preprint

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Background We evaluated the characteristics and outcomes of culture-negative septic shock 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 infection among the culture-positive was the hepatobiliary tract (39.5%), while for the culture-negative 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 degree of organ dysfunction, it was not an independent predictor of death.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Culture-negative and culture-positive septic shock: characteristics and clinical outcomes

Kim

2020

Preprint

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“…The current gold standard in microbiological diagnostics involves culturing blood samples in automated systems such as BACTEC (Becton Dickinson). The flaws of the blood culture method include the time needed to detect growth, which can take up to several days, and its low sensitivity, leading to detection of microbial growth in the range 15-61% of cases with 30-50% on average [6,7].…”

Section: Introductionmentioning

confidence: 99%

Classical Microbiological Diagnostics of Bacteremia: Are the Negative Results Really Negative? What is the Laboratory Result Telling Us About the “Gold Standard”?

et al. 2020

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Standard blood cultures require at least 24–120 h to be reported as preliminary positive. The objective of this study was to compare the reliability of Gram staining and fluorescent in-situ hybridization (FISH) for detecting bacteria in otherwise negative blood culture bottles. Ninety-six sets were taken from patients with a diagnosis of sepsis. Six incomplete blood culture sets and eight blood cultures sets demonstrating positive growth were excluded. We performed Gram stain and FISH on 82 sets taken from post-operative septic patients: 82 negative aerobic blood cultures, 82 anaerobic blood cultures, and 82 blood samples, as well as 57 blood samples taken from healthy volunteers. From the eighty-two blood sets analyzed from the septic patients, Gram stain visualized bacteria in 62.2% of blood samples, 35.4% of the negative aerobic bottles, and in 31.7% of the negative anaerobic bottles. Utilizing FISH, we detected bacteria in 75.6%, 56.1%, and 64.6% respectively. Among the blood samples from healthy volunteers, FISH detected bacteria in 64.9%, while Gram stain detected bacteria in only 38.6%. The time needed to obtain the study results using Gram stain was 1 h, for FISH 4 h, and for the culture method, considering the duration of growth, 5 days. Gram stain and FISH allow quick detection of bacteria in the blood taken directly from a patient. Finding phagocytosed bacteria, which were also detected among healthy individuals, confirms the hypothesis that blood microbiome exists.

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“…Use of an administrative database and ICD‐9‐CM codes is associated with selection and informational biases. However, the previous validation of these ICD‐9‐CM codes partially mitigates these shortcomings 21. The lack of detailed echocardiographic and coronary angiography data that are used to define TTC can result in significant overlap with septic cardiomyopathy.…”

Section: Discussionmentioning

confidence: 99%

“…18, 19, 20, 21 This definition of severe sepsis is consistent with the 2001 American College of Chest Physicians/Society of Critical Care Medicine consensus criteria for severe sepsis: consequent organ dysfunction, hypoperfusion, or hypotension 22. Using previously validated algorithms for microbiological cultures, septic patients were classified into “culture‐positive” and “culture‐negative” sepsis 21. Development of TTC in this cohort of severe sepsis was identified using ICD‐9‐CM code 429.83.…”

Section: Methodsmentioning

confidence: 99%

Tako‐Tsubo Cardiomyopathy in Severe Sepsis: Nationwide Trends, Predictors, and Outcomes

Vallabhajosyula

Deshmukh

Kashani

et al. 2018

JAHA

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BackgroundThere are limited data on the presentation of Takotsubo cardiomyopathy (TTC) in severe sepsis.Methods and ResultsThis was a retrospective cohort study using the National Inpatient Sample database (2007–2013) of all adults with severe sepsis. TTC was identified in patients with severe sepsis using previously validated administrative codes. The primary outcome was in‐hospital mortality, and secondary outcomes included resource utilization and discharge disposition. Regression analysis was performed for the entire cohort and a propensity‐matched sample. An exploratory analysis was performed for predictors of TTC incidence and mortality in TTC. During this 7‐year period, in 7.1‐million hospitalizations for severe sepsis, TTC was diagnosed in 10 746 (0.15%) admissions. TTC was noted more commonly in whites, females, and among 65‐ to 79‐year‐old individuals. TTC was independently associated with lower in‐hospital mortality in severe sepsis (odds ratio, 0.58; 95% confidence interval, 0.51–0.65). This association was more prominent in females (odds ratio, 0.51; 95% confidence interval, 0.44–0.59]) compared with males (odds ratio, 0.69; 95% confidence interval, 0.55–0.85]). Presentation in later years of the study period, middle‐age, female sex, and white race were independent predictors for the diagnosis of TTC. Age ≥80 years, black race, greater comorbidity, and multiorgan dysfunction were independently associated with higher in‐hospital mortality among TTC admissions.Conclusions TTC is observed with increasing frequency in severe sepsis and was associated with a significantly lower in‐hospital mortality compared with patients without TTC. Presentation in later years of the study period, middle age, female sex, and white race were independent predictors for the diagnosis of TTC in severe sepsis.

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Culture-Negative Severe Sepsis

Cited by 159 publications

References 23 publications

Culture-negative and culture-positive septic shock: characteristics and clinical outcomes

Culture-negative and culture-positive septic shock: characteristics and clinical outcomes

Classical Microbiological Diagnostics of Bacteremia: Are the Negative Results Really Negative? What is the Laboratory Result Telling Us About the “Gold Standard”?

Tako‐Tsubo Cardiomyopathy in Severe Sepsis: Nationwide Trends, Predictors, and Outcomes

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