Please use this identifier to cite or link to this item: https://doi.org/10.1186/cc12896
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dc.titleCharacteristics and outcomes of culture-negative versus culture-positive severe sepsis
dc.contributor.authorPhua, J
dc.contributor.authorNgerng, W.J
dc.contributor.authorSee, K.C
dc.contributor.authorTay, C.K
dc.contributor.authorKiong, T
dc.contributor.authorLim, H.F
dc.contributor.authorChew, M.Y
dc.contributor.authorYip, H.S
dc.contributor.authorTan, A
dc.contributor.authorKhalizah, H.J
dc.contributor.authorCapistrano, R
dc.contributor.authorLee, K.H
dc.contributor.authorMukhopadhyay, A
dc.date.accessioned2020-09-09T09:44:29Z
dc.date.available2020-09-09T09:44:29Z
dc.date.issued2013
dc.identifier.citationPhua, 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
dc.identifier.issn1364-8535
dc.identifier.urihttps://scholarbank.nus.edu.sg/handle/10635/175330
dc.description.abstractIntroduction: 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.
dc.sourceUnpaywall 20200831
dc.subjectantibiotic agent
dc.subjectC reactive protein
dc.subjectglucocorticoid
dc.subjectprocalcitonin
dc.subjectvasoactive agent
dc.subjectAcinetobacter baumannii
dc.subjectadult
dc.subjectaged
dc.subjectAPACHE
dc.subjectarticle
dc.subjectartificial ventilation
dc.subjectBacillus
dc.subjectbacterial endocarditis
dc.subjectBacteroides fragilis
dc.subjectblood culture
dc.subjectblood pressure
dc.subjectcerebrospinal fluid
dc.subjectCitrobacter
dc.subjectcohort analysis
dc.subjectcomorbidity
dc.subjectCorynebacterium
dc.subjectEnterobacter cloacae
dc.subjectEnterococcus
dc.subjectEscherichia coli
dc.subjectfemale
dc.subjectGram negative bacterium
dc.subjectHaemophilus influenzae
dc.subjectheart rate
dc.subjecthospitalization
dc.subjecthuman
dc.subjectintensive care unit
dc.subjectKlebsiella pneumoniae
dc.subjectlength of stay
dc.subjectliver abscess
dc.subjectlung lavage
dc.subjectmajor clinical study
dc.subjectmale
dc.subjectmean arterial pressure
dc.subjectmethicillin resistant Staphylococcus aureus
dc.subjectmethicillin susceptible Staphylococcus aureus
dc.subjectmortality
dc.subjectpleura fluid
dc.subjectpriority journal
dc.subjectPropionibacterium
dc.subjectprospective study
dc.subjectPseudomonas aeruginosa
dc.subjectrenal replacement therapy
dc.subjectSalmonella
dc.subjectsepsis
dc.subjectseptic shock
dc.subjectSequential Organ Failure Assessment Score
dc.subjectskin infection
dc.subjectsoft tissue infection
dc.subjectStaphylococcus aureus
dc.subjectStenotrophomonas maltophilia
dc.subjectStreptococcus
dc.subjectStreptococcus pneumoniae
dc.subjecttachycardia
dc.subjecttracheal aspiration procedure
dc.subjecturinary tract infection
dc.subjectbacterial count
dc.subjectcomparative study
dc.subjectGram positive bacterium
dc.subjectisolation and purification
dc.subjectmicrobiology
dc.subjectmiddle aged
dc.subjectprocedures
dc.subjectsepsis
dc.subjecttreatment outcome
dc.subjecttrends
dc.subjectAged
dc.subjectCohort Studies
dc.subjectColony Count, Microbial
dc.subjectFemale
dc.subjectGram-Negative Bacteria
dc.subjectGram-Positive Bacteria
dc.subjectHospital Mortality
dc.subjectHumans
dc.subjectIntensive Care Units
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectProspective Studies
dc.subjectSepsis
dc.subjectTreatment Outcome
dc.typeArticle
dc.contributor.departmentMEDICINE
dc.contributor.departmentDUKE-NUS MEDICAL SCHOOL
dc.description.doi10.1186/cc12896
dc.description.sourcetitleCritical Care
dc.description.volume17
dc.description.issue5
dc.description.pageR202
dc.published.statePublished
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