Prediction of culture-positive sepsis and selection of empiric antibiotics in critically ill patients with complicated intra-abdominal infections: a retrospective study

Abstract Purpose To compare the mortality rates between culture-positive and culture-negative sepsis in complicated intra-abdominal infections (cIAI) and investigate the predictors of culture-positivity and their causative microorganisms. Materials and methods The medical records of 1581 adult patients who underwent emergency gastrointestinal surgery between January 2013 and December 2018 were reviewed retrospectively. A total of 239 patients with sepsis or septic shock who were admitted to an emergency department, underwent emergency surgery for cIAI, and needed postoperative intensive care unit care were included and divided into two groups according to their initial blood and peritoneal culture results. Results Among the 239 patients, 200 were culture-negative and 39 were culture-positive. The culture-positive group had higher in-hospital (35.9% vs 14.5%; P = .001) and 30-day mortality (30.8% vs 12.0%; P = .003) than the culture-negative group. Colon involvement (OR 4.211; 95% CI 1.909–9.287; P < .001) and higher Sequential Organ Failure Assessment (SOFA) score (OR 1.169; 95% CI 1.065–1.282; P = .001) were shown to be the predictors of culture-positive sepsis for cIAI. Regarding antibiotic sensitivity, 31.6% of the gram-positive bacteria were methicillin-resistant and 42.1% of the gram-negative bacteria were extended spectrum β-lactamase-producing Enterobacteriaceae. Conclusions Patients with cIAI had higher mortality rates in culture-positive sepsis than in culture-negative sepsis. High SOFA score and colon involvement were the risk factors associated with culture-positivity. The most common single species grown in the blood or peritoneal cultures was Escherichia coli, and the most common group was Gram-positive cocci.

Download Full-text

Bacteremic sepsis leads to higher mortality when adjusting for confounders with propensity score matching

Scientific Reports ◽

10.1038/s41598-021-86346-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Lisa Mellhammar ◽

Fredrik Kahn ◽

Caroline Whitlow ◽

Thomas Kander ◽

Bertil Christensson ◽

...

Keyword(s):

Intensive Care ◽

Clinical Review ◽

Pathogen Detection ◽

Mortality Rates ◽

Blood Cultures ◽

Population Heterogeneity ◽

Sepsis Diagnosis ◽

Culture Positive ◽

Culture Negative ◽

Microbial Samples

AbstractOne can falsely assume that it is well known that bacteremia is associated with higher mortality in sepsis. Only a handful of studies specifically focus on the comparison of culture-negative and culture-positive sepsis with different conclusions depending on study design. The aim of this study was to describe outcome for critically ill patients with either culture-positive or -negative sepsis in a clinical review. We also aimed to identify subphenotypes of sepsis with culture status included as candidate clinical variables. Out of 784 patients treated in intensive care with a sepsis diagnosis, blood cultures were missing in 140 excluded patients and 95 excluded patients did not fulfill a sepsis diagnosis. Of 549 included patients, 295 (54%) had bacteremia, 90 (16%) were non-bacteremic but with relevant pathogens detected and in 164 (30%) no relevant pathogen was detected. After adjusting for confounders, 90-day mortality was higher in bacteremic patients, 47%, than in non-bacteremic patients, 36%, p = 0.04. We identified 8 subphenotypes, with different mortality rates, where pathogen detection in microbial samples were important for subphenotype distinction and outcome. In conclusion, bacteremic patients had higher mortality than their non-bacteremic counter-parts and bacteremia is more common in sepsis when studied in a clinical review. For reducing population heterogeneity and improve the outcome of trials and treatment for sepsis, distinction of subphenotypes might be useful and pathogen detection an important factor.

Download Full-text

Association Between Diabetic Foot Infection Wound Culture Positivity and 1-Year Admission for Invasive Infection: A Multi-Center Cohort Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab172 ◽

2021 ◽

Author(s):

Westyn Branch-Elliman ◽

Daniel Sturgeon ◽

Adolf W Karchmer ◽

Hillary J Mull

Keyword(s):

Diabetic Foot ◽

Systemic Infection ◽

Causative Organism ◽

Invasive Infection ◽

Diabetic Foot Ulcers ◽

Diabetic Foot Infections ◽

Culture Positivity ◽

Wound Culture ◽

Culture Positive ◽

Culture Negative

Abstract Inpatients with culture-positive diabetic foot infections are at elevated risk for subsequent invasive infection with the same causative organism. In outpatients with index diabetic foot ulcers, we found that wound culture positivity was independently associated with increased odds of 1-year admission for systemic infection when compared to culture-negative wounds.

Download Full-text

Isolation of dacrocystitis causing bacteria among the patients of East Godavari district, Andhra Pradesh

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v15i3.21452 ◽

2016 ◽

Vol 15 (3) ◽

pp. 399-402

Author(s):

T Jaya Chandra ◽

K Satish ◽

R Selva Raj ◽

YV Sharma

Keyword(s):

Infection Rate ◽

Medical Science ◽

Gram Negative Bacteria ◽

Gram Positive ◽

Gram Positive Bacteria ◽

Culture Positivity ◽

Microbial Analysis ◽

The Needy ◽

Culture Positive ◽

Gram Positive Cocci

Introduction: Inflammation of the lacrimal sac, dacryocystitis is one of the important causes of ocular morbidity in Indian subcontinent.Objective: To isolate and identify the aerobic bacterial pathogens associated with dacryocystitis and to determine their antibacterial sensitivity pattern.Materials and methods: A total of 304 individuals were included in the study. Blocked tissue / pus was collected and microbial analysis was done.Results: Infection rate was more in the female than male, statistically highly significant (p<0.0001). The culture positivity was 91% (277/304), infection rate was maximum at the age of 40-50 years {200/204, 98% (p<0.0001)}. In culture positive cases gram positive cocci is commonly isolated. Most of gram positive bacteria are sensitive to Chloramphenicol. Gram negative bacteria were sensitive to Gentamycin, Chloramphenicol and Ciprofloxacin.Conclusion: Knowledge of the bacteriology of dacryocystitis and the susceptibility of the bacteria towards antibiotics helped the needy for proper treatment, so that time as well as money can be saved.Bangladesh Journal of Medical Science Vol.15(3) 2016 p.399-402

Download Full-text

Multicentre registry data analysis comparing outcomes of culture-negative peritonitis and different subtypes of culture-positive peritonitis in peritoneal dialysis patients

Peritoneal Dialysis International ◽

10.1177/0896860819879891 ◽

2020 ◽

Vol 40 (1) ◽

pp. 47-56 ◽

Cited By ~ 1

Author(s):

Htay Htay ◽

Yeoungjee Cho ◽

Elaine M Pascoe ◽

Carmel Hawley ◽

Philip A Clayton ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Primary Outcome ◽

Catheter Removal ◽

Dialysis Patients ◽

Gram Positive ◽

Pseudomonas Species ◽

Gram Negative Organisms ◽

Culture Positive ◽

Culture Negative ◽

Related Mortality

Background: The outcomes of culture-negative peritonitis in peritoneal dialysis (PD) patients have been reported to be superior to those of culture-positive peritonitis. The current study aimed to examine whether this observation also applied to different subtypes of culture-positive peritonitis. Methods: This multicentre registry study included all episodes of peritonitis in adult PD patients in Australia between 2004 and 2014. The primary outcome was medical cure. Secondary outcomes were catheter removal, hemodialysis transfer, relapsing/recurrent peritonitis and peritonitis-related death. These outcomes were analyzed using mixed effects logistic regression. Results: Overall, 11,122 episodes of peritonitis occurring in 5367 patients were included. A total of 1760 (16%) episodes were culture-negative, of which 77% were medically cured. Compared with culture-negative peritonitis, the odds of medical cure were lower in peritonitis caused by Staphylococcus aureus (adjusted odds ratio (OR) 0.62, 95% confidence interval (CI) 0.52–0.73), Pseudomonas species (OR 0.20, 95% CI 0.16–0.26), other gram-negative organisms (OR 0.48, 95% CI 0.41–0.56), polymicrobial organisms (OR 0.30, 95% CI 0.25–0.35), fungi (OR 0.02, 95% CI 0.01–0.03), and other organisms (OR 0.61, 95% CI 0.49–0.76), while the odds were similar in other (non-staphylococcal) gram-positive organisms (OR 1.11, 95% CI 0.97–1.28). Similar results were observed for catheter removal and hemodialysis transfer. Compared with culture-negative peritonitis, peritonitis-related mortality was significantly higher in culture-positive peritonitis except that due to other gram-positive organisms. There was no difference in the odds of relapsing/recurrent peritonitis between culture-negative and culture-positive peritonitis. Conclusion: Culture-negative peritonitis had superior outcomes compared to culture-positive peritonitis except for non-staphylococcal gram-positive peritonitis.

Download Full-text

Comparison Between Culture-Positive and Culture-Negative Septic Shock in Emergency Department Patients

10.21203/rs.3.rs-1181409/v1 ◽

2022 ◽

Author(s):

Yen-Chang Huang ◽

Chi-Chieh Hung ◽

Yong-Ye Yang ◽

Tsung-Han Wang ◽

Yin-Chou Hsu

Keyword(s):

Emergency Department ◽

Septic Shock ◽

Clinical Characteristics ◽

Management Strategies ◽

Intensive Care Unit Care ◽

Antibiotic Administration ◽

Retrospective Case ◽

Emergency Department Patients ◽

Culture Positive ◽

Culture Negative

Abstract Culture results in patients with septic shock affect their management strategies. Our study aimed to compare the clinical characteristics and outcomes of patients with culture-negative septic shock (CNSS) and culture-positive septic shock (CPSS). A single-center, retrospective, case-control study included adult patients diagnosed with septic shock in the emergency department between January 1, 2019 and March 31, 2020. They were divided into CNSS and CPSS groups based on their culture results. Patients with CPSS (63.7%, 311/488) and CNSS (36.3%, 177/488) were identified. The CPSS and CNSS groups had comparable clinical outcomes, including mechanical ventilation (29.6% vs. 32.8%, p = 0.46), renal replacement therapy (19.3% vs. 23.2%, p = 0.31), intensive care unit care (51.8% vs. 45.2%, p = 0.16), 30-day (35.7% vs. 36.7%, p = 0.82) and in-hospital mortality (39.5% vs. 41.8%, p = 0.63). The duration (13 [8−19] vs. 16 [10−23], days, p = 0.04) and de-escalation timing (5 [2−10] vs. 9 [7−12], day, p = 0.02) of antibiotic administration in the CNSS group was significantly shorter and earlier than in the CPSS group. Patients with CNSS and CPSS had similar clinical characteristics and adverse outcome proportions. Physicians can evaluate the feasibility of early de-escalation or discontinuation of antibiotic administration in CNSS patients with clinical improvement.

Download Full-text

Elevated Plasma Matrix Metalloproteinase-8 associates with Sputum Culture Positivity in Pulmonary Tuberculosis

10.1101/2021.11.15.21265734 ◽

2021 ◽

Author(s):

Naomi F Walker ◽

Farina Karim ◽

Mahomed-Yunus S Moosa ◽

Sashen Moodley ◽

Matilda Mazibuko ◽

...

Keyword(s):

Mycobacterium Tuberculosis ◽

Matrix Metalloproteinase ◽

Treatment Monitoring ◽

Elevated Plasma ◽

Tb Treatment ◽

Culture Positivity ◽

Potential Biomarker ◽

Culture Positive ◽

Culture Negative ◽

Procollagen Iii

Current methods for tuberculosis (TB) treatment monitoring are suboptimal. We evaluated plasma matrix metalloproteinase (MMP) and procollagen III N-terminal propeptide concentrations before and during TB treatment as biomarkers. Plasma MMP-1, -8 and -10 significantly decreased during treatment. Plasma MMP-8 was increased in sputum Mycobacterium tuberculosis culture positive relative to culture negative participants, prior to (median 4609 pg/ml, IQR 2353-9048 vs 775 pg/ml, IQR 551-4920, p=0.019) and after 6 months (median 3650, IQR 1214-3888 vs 720, IQR 551-1321, p=0.008) of TB treatment. Consequently, plasma MMP-8 is a potential biomarker to enhance TB treatment monitoring and screen for possible culture positivity.

Download Full-text

PCR Method for Detection of Adenovirus in Urine of Healthy and Human Immunodeficiency Virus-Infected Individuals

Journal of Clinical Microbiology ◽

10.1128/jcm.36.11.3323-3326.1998 ◽

1998 ◽

Vol 36 (11) ◽

pp. 3323-3326 ◽

Cited By ~ 95

Author(s):

Marcela Echavarria ◽

Michael Forman ◽

John Ticehurst ◽

J. Stephen Dumler ◽

Patricia Charache

Keyword(s):

Human Immunodeficiency Virus ◽

Urine Samples ◽

Culture Positivity ◽

Immunodeficiency Virus ◽

History Of ◽

Pcr Method ◽

Urine Processing ◽

Culture Positive ◽

Culture Negative

Adenoviruses (AdV) cause diseases that range from localized, self-limited illnesses to fatal infections in immunocompromised patients. Culture is assumed to be sensitive but requires viable virus and up to 3 weeks for detection, and it can be inhibited by bacterial contamination. A new PCR method amplifying a region of the hexon gene was developed in order to detect AdV in urine more rapidly and with greater sensitivity than obtainable by culture technology. All 18 serotypes tested were detected. Quantitatively, with optimized urine processing, AdV PCR detected 0.2 PFU/ml (serotype 11) and 10 DNA copies/ml (serotype 2). Serially collected urine samples from human immunodeficiency virus (HIV)-infected patients with concurrent cytomegalovirus retinitis were divided into three groups: AdV culture-positive samples, AdV culture-negative or bacterially contaminated samples from patients with a history of AdV culture-positive urines, and AdV culture-negative samples from patients without a history of AdV culture positivity. Urine samples from healthy adults were also tested by culture and PCR to screen for asymptomatic shedding. Amplification was assessed with and without prior DNA purification. AdV was detected by PCR in 90% of culture-positive urines (100% of unclotted samples, e.g., those culture positive after storage for PCR testing), 71% of culture-negative or bacterially contaminated urines from AdV-infected patients, and 28% from AdV culture-negative patients. Healthy volunteers were culture negative for AdV, and 96% were PCR negative. The new AdV PCR method is rapid and sensitive and can detect viral DNA in samples for which culturing is problematic. The role of AdV replication during HIV infection merits further investigation with sensitive tools such as PCR.

Download Full-text

Quantitative and Qualitative Assessments of Cholesterol Association With Bacterial Infection Type in Sepsis and Septic Shock

Journal of Intensive Care Medicine ◽

10.1177/0885066620931473 ◽

2020 ◽

pp. 088506662093147

Author(s):

Lauren Page Black ◽

Michael A. Puskarich ◽

Morgan Henson ◽

Taylor Miller ◽

Srinivasa T. Reddy ◽

...

Keyword(s):

Disease Severity ◽

Infection Type ◽

Density Lipoprotein ◽

Hdl Cholesterol ◽

Gram Positive ◽

Data Set ◽

Gram Negative ◽

Cholesterol Levels ◽

Culture Positive ◽

Culture Negative

Background: Reduced cholesterol levels are associated with increased organ failure and mortality in sepsis. Cholesterol levels may vary by infection type (gram negative vs positive), possibly reflecting differences in cholesterol-mediated bacterial clearance. Methods: This was a secondary analysis of a combined data set of 2 prospective cohort studies of adult patients meeting Sepsis-3 criteria. Infection types were classified as gram negative, gram positive, or culture negative. We investigated quantitative (levels) and qualitative (dysfunctional high-density lipoprotein [HDL]) cholesterol differences. We used multivariable logistic regression to control for disease severity. Results: Among 171 patients with sepsis, infections were gram negative in 67, gram positive in 46, and culture negative in 47. Both gram-negative and gram-positive infections occurred in 11 patients. Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and HDL cholesterol (HDL-C) levels were lower for culture-positive sepsis at enrollment (TC, P < .001; LDL-C, P < .001; HDL-C, P = .011) and persisted after controlling for disease severity. Similarly, cholesterol levels were lower among culture-positive patients at 48 hours (TC, P = .012; LDL-C, P = .029; HDL-C, P = .002). Triglyceride (TG) levels were lower at enrollment ( P =.033) but not at 48 hours ( P = .212). There were no differences in dysfunctional HDL. Among bacteremic patients, cholesterol levels were lower at enrollment (TC, P = .010; LDL-C, P = .010; HDL-C, P ≤ .001; TG, P = .005) and at 48 hours (LDL-C, P = .027; HDL-C, P < .001; TG, P = .020), except for 48 hour TC ( P = .051). In the bacteremia subgroup, enrollment TC and LDL-C were lower for gram-negative versus gram-positive infections (TC, P = .039; LDL-C, P = .023). Conclusion: Cholesterol levels are significantly lower among patients with culture-positive sepsis and bacteremia.

Download Full-text

Comparison of complement component C3 level with bacterial infections in decompensated liver disease patients in a tertiary care hospital

International Journal of Bioassays ◽

10.21746/ijbio.2016.12.003 ◽

2016 ◽

Vol 5 (12) ◽

pp. 5128

Author(s):

Rajeswari Jayakumar* ◽

Thasneem Banu S. ◽

Venkatesh K. G.

Keyword(s):

Liver Disease ◽

Bacterial Infections ◽

Complement Component ◽

Gram Positive ◽

Decompensated Liver Disease ◽

Gram Negative ◽

Complement Component C3 ◽

Culture Positive ◽

Culture Negative ◽

Gram Positive Cocci

Bacterial infections are more common in decompensated liver disease patients with low level of complement component 3 and causes 30%-50% of deaths. Therefore, this study done to determine the various bacterial agents causing infections in decompensated liver disease patients and to estimate the level of C3 component of complement by Enzyme linked immunosorbent assay. A prospective study was conducted over a period of one year in Madras Medical College. Ascitic fluid, urine, sputum, wound swab blood and serum were collected. All the samples were processed through Gram’s stain and culture. The organisms were identified by standard protocols and antibiotic susceptibility testing and to correlate the bacterial infections with complement C3 level by ELISA. Out of 100 samples, culture positivity seen in 54[54%]. In 54 culture, positive isolates, 41(76%) were Gram Negative bacilli and 13 (24%) were Gram Positive cocci. Among Gram negative bacilli, Escherichia coli and in Gram positive cocci, Staphylococcus aureus was the most common isolates. The most common infections were spontaneous bacterial peritonitis [29.6%] followed by urinary tract infections [26%], pneumonia [20.3%], Spontaneous bacteraemia [16.7%], and skin and soft-tissue infections [7.4%]. Out of 100patients, 66(66%) patients had low complement component C3 level. Of which 42(63.6%) patients were cultures positive and 24(36.4%) were culture negative. 34(34%) patients had normal complement component C3 level, of which 29 (85.3%) were culture negative and 5 (14.7%) were culture positive.

Download Full-text