Please use this identifier to cite or link to this item: https://doi.org/10.1186/cc12896
Title: Characteristics and outcomes of culture-negative versus culture-positive severe sepsis
Authors: Phua, J 
Ngerng, W.J
See, K.C 
Tay, C.K 
Kiong, T
Lim, H.F 
Chew, M.Y 
Yip, H.S 
Tan, A
Khalizah, H.J
Capistrano, R
Lee, K.H
Mukhopadhyay, A 
Keywords: antibiotic agent
C reactive protein
glucocorticoid
procalcitonin
vasoactive agent
Acinetobacter baumannii
adult
aged
APACHE
article
artificial ventilation
Bacillus
bacterial endocarditis
Bacteroides fragilis
blood culture
blood pressure
cerebrospinal fluid
Citrobacter
cohort analysis
comorbidity
Corynebacterium
Enterobacter cloacae
Enterococcus
Escherichia coli
female
Gram negative bacterium
Haemophilus influenzae
heart rate
hospitalization
human
intensive care unit
Klebsiella pneumoniae
length of stay
liver abscess
lung lavage
major clinical study
male
mean arterial pressure
methicillin resistant Staphylococcus aureus
methicillin susceptible Staphylococcus aureus
mortality
pleura fluid
priority journal
Propionibacterium
prospective study
Pseudomonas aeruginosa
renal replacement therapy
Salmonella
sepsis
septic shock
Sequential Organ Failure Assessment Score
skin infection
soft tissue infection
Staphylococcus aureus
Stenotrophomonas maltophilia
Streptococcus
Streptococcus pneumoniae
tachycardia
tracheal aspiration procedure
urinary tract infection
bacterial count
comparative study
Gram positive bacterium
isolation and purification
microbiology
middle aged
procedures
sepsis
treatment outcome
trends
Aged
Cohort Studies
Colony Count, Microbial
Female
Gram-Negative Bacteria
Gram-Positive Bacteria
Hospital Mortality
Humans
Intensive Care Units
Male
Middle Aged
Prospective Studies
Sepsis
Treatment Outcome
Issue Date: 2013
Citation: Phua, J, Ngerng, W.J, See, K.C, Tay, C.K, Kiong, T, Lim, H.F, Chew, M.Y, Yip, H.S, Tan, A, Khalizah, H.J, Capistrano, R, Lee, K.H, Mukhopadhyay, A (2013). Characteristics and outcomes of culture-negative versus culture-positive severe sepsis. Critical Care 17 (5) : R202. ScholarBank@NUS Repository. https://doi.org/10.1186/cc12896
Abstract: Introduction: Culture-negative sepsis is a common but relatively understudied condition. The aim of this study was to compare the characteristics and outcomes of culture-negative versus culture-positive severe sepsis. Methods: This was a prospective observational cohort study of 1001 patients who were admitted to the medical intensive care unit (ICU) of a university hospital from 2004 to 2009 with severe sepsis. Patients with documented fungal, viral, and parasitic infections were excluded. Results: There were 415 culture-negative patients (41.5%) and 586 culture-positive patients (58.5%). Gram-positive bacteria were isolated in 257 patients, and gram-negative bacteria in 390 patients. Culture-negative patients were more often women and had fewer comorbidities, less tachycardia, higher blood pressure, lower procalcitonin levels, lower Acute Physiology and Chronic Health Evaluation II (median 25.0 (interquartile range 19.0 to 32.0) versus 27.0 (21.0 to 33.0), P = 0.001) and Sequential Organ Failure Assessment scores, less cardiovascular, central nervous system, and coagulation failures, and less need for vasoactive agents than culture-positive patients. The lungs were a more common site of infection, while urinary tract, soft tissue and skin infections, infective endocarditis and primary bacteremia were less common in culture-negative than in culture-positive patients. Culture-negative patients had a shorter duration of hospital stay (12 days (7.0 to 21.0) versus 15.0 (7.0 to27.0), P = 0.02) and lower ICU mortality than culture-positive patients. Hospital mortality was lower in the culture-negative group (35.9%) than in the culture-positive group (44.0%, P = 0.01), the culture-positive subgroup, which received early appropriate antibiotics (41.9%, P = 0.11), and the culture-positive subgroup, which did not (55.5%, P < 0.001). After adjusting for covariates, culture positivity was not independently associated with mortality on multivariable analysis.Conclusions: Significant differences between culture-negative and culture-positive sepsis are identified, with the former group having fewer comorbidities, milder severity of illness, shorter hospitalizations, and lower mortality. © 2013 Phua et al.; licensee BioMed Central Ltd.
Source Title: Critical Care
URI: https://scholarbank.nus.edu.sg/handle/10635/175330
ISSN: 1364-8535
DOI: 10.1186/cc12896
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