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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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