To analyze the prognostic role of positive cultures in patients with sepsis.
Methods:
A prospective cohort study in a tertiary referral hospital in Medellín, Colombia. Adults older than 18 years of age with a bacterial infection diagnosis according to Centers for Disease Control criteria and sepsis (evidence of organ dysfunction) were included. A logistic regression model was used to determine the association between positive cultures and hospital mortality, and a Cox regression with a competing risk modeling approach was used to determine the association between positive cultures and hospital stay as well as secondary infections.
Results:
Overall, 408 patients had positive cultures, of which 257 were blood culture, and 153 had negative cultures. Patients with positive cultures had a lower risk of mortality (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.27-0.68), but this association was not maintained after adjusting for confounding factors (OR, 0.56; 95% CI, 0.31-1.01). No association was found with the hospital stay (adjusted subhazard ratio [SHR], 1.06; 95% CI, 0.83-1.35). There was no association between positive cultures and the presence of secondary infections (adjusted SHR, 0.99; 95% CI, 0.58-1.71).
Conclusion:
Positive cultures are not associated with prognosis in patients with sepsis.
CaironiP. A call for research on sepsis in developing countries. Minerva Anestesiol. 2012;78(11):1196–1198.
2.
LabelleAJuangPReichleyR, et al.The determinants of hospital mortality among patients with septic shock receiving appropriate initial antibiotic treatment*. Crit Care Med. 2012;40(7):2016–2021.
3.
SilvaECavalcantiABBuganoDDG, et al.Do established prognostic factors explain the different mortality rates in ICU septic patients around the world?Minerva Anestesiol. 2012;78(11):1215–1225.
4.
GuoYGaoWYangHMaCSuiS.De-escalation of empiric antibiotics in patients with severe sepsis or septic shock: a meta-analysis. Heart Lung. 2016;45(5):454–459.
HoranTCAndrusMDudeckMA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309–332.
7.
KnausWADraperEAWagnerDPZimmermanJE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818–829.
8.
VincentJLMorenoRTakalaJ, et al.The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intens Care Med. 1996;22(7):707–710.
9.
CharlsonMEPompeiPAlesKLMacKenzieCR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–383.
10.
DellingerRPLevyMMRhodesA, et al.Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39(2):165–228.
11.
PhuaJNgerngWJSeeKC, et al.Characteristics and outcomes of culture-negative versus culture-positive severe sepsis. Crit Care. 2013;17(5):R202.
12.
DupontWDPlummerWD. PS: Power and Sample Size Calculation Software, version 3.1.2; 2014.
13.
ClevelandWS. Robust locally weighted regression and smoothing scatterplots. J Am Statist Assoc. 1979;74(368):829–836.
14.
KatzMH. Multivariable Analysis: A Practical Guide for Clinicians and Public Health Researchers. 2011.
15.
LindenauerPKLaguTShiehMSPekowPSRothbergMB. Association of diagnostic coding with trends in hospitalizations and mortality of patients with pneumonia, 2003-2009. JAMA. 2012;307(13):1405–1413.
ZaharJRTimsitJFGarrouste-OrgeasM, et al.Outcomes in severe sepsis and patients with septic shock: pathogen species and infection sites are not associated with mortality*. Criti Care Med. 2011;39(8):1886–1895.
18.
Fariñas-AlvarezCFariñasMCFernández-MazarrasaCLlorcaJDelgado-RodríguezM. Epidemiological differences between sepsis syndrome with bacteremia and culture-negative sepsis. Infect Control Hosp Epidemiol. 2000;21(10):639–644.
19.
Brun-BuissonCDoyonFCarletJ, et al.Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. A multicenter prospective study in intensive care units. French ICU Group for Severe Sepsis. JAMA. 1995;274(12):968–974.
20.
DegoricijaVSharmaMLegacAGradiserMSeferSVucicevićZ. Survival analysis of 314 episodes of sepsis in medical intensive care unit in university hospital: impact of intensive care unit performance and antimicrobial therapy. Croat Med J. 2006;47(3):385–397.
21.
ReyesWJBrimioulleSVincentJL. Septic shock without documented infection: an uncommon entity with a high mortality. Intensive Care Med. 1999;25(11):1267–1270.
22.
YangSCLiaoKMChenCWLinWC. Positive blood culture is not associated with increased mortality in patients with sepsis-induced acute respiratory distress syndrome. Respirology. 2013;18(8):1210–1216.
23.
SaldíasPFReyesBTSáezBJ, et al.Predictores clínicos de bacteriemia en adultos inmunocompetentes hospitalizados por neumonía adquirida en la comunidad. Revista Médica de Chile. 2015;143(5):553–561.
24.
CuervoACorreaJGarcésDAscuntarJLeónAJaimesFA. Desarrollo y validación de un modelo predictor para bacteriemia en pacientes hospitalizados por el servicio de urgencias con sospecha de infección. Rev Chilena Infectol. 2016;33(2):150–158.
25.
RodríguezFBarreraLDe La RosaG, et al.The epidemiology of sepsis in Colombia: a prospective multicenter cohort study in ten university hospitals. Criti Care Med. 2011;39(7):1675–1682.
26.
CerroLValenciaJCallePLeónAJaimesF. Validation of APACHE II and SOFA scores in 2 cohorts of patients with suspected infection and sepsis, not admitted to critical care units [in Spanish]. Rev Esp Anestesiol Reanim. 2014;61(3):125–132.
27.
SingerMDeutschmanCSSeymourCW, et al.The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016;315(8):801–810.
