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

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.

scholarly journals Risk factors for mortality and mortality rates in interstitial lung disease patients in the intensive care unit

2018 ◽  
Vol 27 (150) ◽  
pp. 180061 ◽  
Author(s):  
Julio A. Huapaya ◽  
Erin M. Wilfong ◽  
Christopher T. Harden ◽  
Roy G. Brower ◽  
Sonye K. Danoff
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Interstitial Lung Disease ◽  
Mortality Rate ◽  
Lung Disease ◽  
Mortality Rates ◽  
Population Heterogeneity

Data on interstitial lung disease (ILD) outcomes in the intensive care unit (ICU) is of limited value due to population heterogeneity. The aim of this study was to examine risk factors for mortality and ILD mortality rates in the ICU.We performed a systematic review using five databases. 50 studies were identified and 34 were included: 17 studies on various aetiologies of ILD (mixed-ILD) and 17 on idiopathic pulmonary fibrosis (IPF). In mixed-ILD, elevated APACHE score, hypoxaemia and mechanical ventilation are risk factors for mortality. No increased mortality was found with steroid use. Evidence is inconclusive on advanced age. In IPF, evidence is inconclusive for all factors except mechanical ventilation and hypoxaemia. The overall in-hospital mortality was available in 15 studies on mixed-ILD (62% in 2001–2009 and 48% in 2010–2017) and 15 studies on IPF (79% in 1993–2004 and 65% in 2005–2017). Follow-up mortality rate at 1 year ranged between 53% and 100%.Irrespective of ILD aetiology, mechanical ventilation is associated with increased mortality. For mixed-ILD, hypoxaemia and APACHE scores are also associated with increased mortality. IPF has the highest mortality rate among ILDs, but since 1993 the rate appears to be declining. Despite improving in-hospital survival, overall mortality remains high.

scholarly journals Comparative Evaluation of Enteric Bacterial Culture and a Molecular Multiplex Syndromic Panel in Children with Acute Gastroenteritis

2019 ◽  
Vol 57 (6) ◽  
Author(s):  
Thomas Kellner ◽  
Brendon Parsons ◽  
Linda Chui ◽  
Byron M. Berenger ◽  
Jianling Xie ◽  
...  
Keyword(s):  
Pathogen Detection ◽  
Rectal Swab ◽  
Bacterial Pathogen ◽  
Positive Culture ◽  
Content Type ◽  
Negative Culture ◽  
Percent Agreement ◽  
Stool Samples ◽  
Culture Positive ◽  
Culture Negative

ABSTRACTAlthough enteric multianalyte syndromic panels are increasingly employed, direct comparisons with traditional methods and the inclusion of host phenotype correlations are limited. Luminex xTAG gastrointestinal pathogen panel (GPP) and culture results are highly concordant. However, phenotypic and microbiological confirmatory testing raises concerns regarding the accuracy of the GPP, especially forSalmonellaspp. A total of 3,089 children with gastroenteritis submitted stool specimens, rectal swab specimens, and clinical data. The primary outcome was bacterial pathogen detection agreement for shared targets between culture and the Luminex xTAG GPP. Secondary analyses included phenotype assessment, additional testing of GPP-negative/culture-positive isolate suspensions with the GPP, and in-house and commercial confirmatory nucleic acid testing of GPP-positive/culture-negative extracts. The overall percent agreement between technologies was >99% for each pathogen.Salmonellaspp. were detected in specimens from 64 participants: 12 (19%) by culture only, 9 (14%) by GPP only, and 43 (67%) by both techniques. Positive percent agreement forSalmonellaspp. was 78.2% (95% confidence interval [CI], 64.6%, 87.8%). Isolate suspensions from the 12 participants with specimens GPP negative/culture positive forSalmonellatested positive by GPP. Specimens GPP positive/culture negative forSalmonellaoriginated in younger children with less diarrhea and more vomiting. GPP-positive/culture-negative specimen extracts tested positive using additional assays for 0/2Campylobacter-positive specimens, 0/4Escherichia coliO157-positive specimens, 0/9Salmonella-positive specimens, and 2/3Shigella-positive specimens. For both rectal swab and stool samples, the median cycle threshold (CT) values, determined using quantitative PCR, were higher for GPP-negative/culture-positive samples than for GPP-positive/culture-positive samples (for rectal swabs, 36.9 [interquartile range {IQR}, 33.7, 37.1] versus 30.0 [IQR, 26.2, 33.2], respectively [P = 0.002]; for stool samples, 36.9 [IQR, 33.7, 37.1] versus 29.0 [IQR, 24.8, 30.8], respectively [P = 0.001]). GPP and culture have excellent overall agreement; however, for specific pathogens, GPP is less sensitive than culture and, notably, identifies samples false positive forSalmonellaspp.

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

2020 ◽  
Author(s):  
Joohyun Sim ◽  
Sung Soo Hong ◽  
Jae Young Kwak ◽  
Yun Tae Jung
Keyword(s):  
Sofa Score ◽  
Gastrointestinal Surgery ◽  
Mortality Rates ◽  
Intensive Care Unit Care ◽  
Gram Positive ◽  
Culture Positivity ◽  
Postoperative Intensive Care ◽  
Abdominal Infections ◽  
Culture Positive ◽  
Culture Negative

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.

scholarly journals Higher mortality in bacteremic sepsis - A propensity score matched study

2020 ◽  
Author(s):  
Lisa Mellhammar ◽  
Fredrik Kahn ◽  
Caroline Whitlow ◽  
Thomas Kander ◽  
Bertil Christensson ◽  
...  
Keyword(s):  
Propensity Score ◽  
Chart Review ◽  
Propensity Score Analysis ◽  
Sepsis Diagnosis ◽  
Score Analysis ◽  
Body Location ◽  
Matched Study ◽  
Clinical Chart ◽  
Culture Positive ◽  
Microbial Samples

Abstract The aim of this study was to describe outcome for critically ill patients with either culture-positive or -negative sepsis.In a clinical chart review of patients with a sepsis diagnosis treated in an intensive Care Unit (ICU), those who fulfilled sepsis-3 criteria and at had least one blood culture sampled ±48h from ICU admission were included. In a propensity score analysis bacteremic and non-bacteremic patients were matched with regard to age, comorbidities, site of infection and antimicrobial therapy prior to blood cultures.Out of 784 patients treated in the ICU with a sepsis diagnosis, blood cultures were missing in 140 excluded patients and additionally 95 excluded patients did not fulfill a sepsis diagnosis. In total 549 patients were included, 295 (54%) with bacteremia, 90 (16%) were non-bacteremic but had relevant pathogens detected from another body location and in 164 (30%) no relevant pathogen was detected in microbial samples. After the propensity score analysis, 90-day mortality was higher in bacteremic patients, 47%, than in non-bacteremic patients, 36%, p =0.04. 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.

Characteristics and outcomes of culture-negative versus culture-positive with fungus in sepsis patients: a retrospective analysis of the MIMIC-III database

2020 ◽  
Author(s):  
Zhiye Zou ◽  
Ming Wu
Keyword(s):  
Intensive Care ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Antifungal Therapy ◽  
Antifungal Drugs ◽  
Positive Group ◽  
Mimic Iii ◽  
Culture Positive ◽  
Culture Negative

Abstract BACKGROUND: We compared the characteristics of culture-positive and culture-negative with fungi in septic patients to determine whether fungi culture status is associated with mortality and the relationship between antifungal therapy and sepsis patient mortality.METHODS: The study was based on the Medical Information Mart for Intensive Care (MIMIC) III database, we included all intensive care unit (ICU) admissions between 2001 and 2012 with sepsis, which met the Martin’s criteria. The primary outcome was hospital mortality. Secondary outcomes included the usage of antifungal drugs, duration of mechanical ventilation and hospital stay. Multivariable logistic regression and propensity score matching were used to investigate any association.RESULTS: The study population included 836 fungi-positive patients (16.6%) and 4191 fungi-negative patients (83.4%). Fungi-positive patients had more congestive heart failure and chronic pulmonary, higher sequential organ failure assessment (SOFA), and more need for renal replacement therapy on day one than fungi-negative patients. There was no correlation between antifungal therapy and hospital mortality (adjusted odds ratio = 1.03, 95% CI [0.89, 1.20]; P=0.676）. Hospital mortality was lower in the fungi-negative group (25.5%) than in the fungi-positive group (37.3%, P<0.001). After propensity score matching, 613 cases from each group were matched. The hospital mortality remained significantly higher in the fungi-positive group (167/613 vs. 216/613, p=0.003).CONCLUSIONS: Although residual confounding cannot be excluded, significant differences between fungi-positive and fungi-negative sepsis are identified, with the former group having more comorbidities, worse severity of illness, longer hospitalizations, and higher mortality. Antifungal therapy does not affect the outcome.

Prognostic Value Of Blood Cultures as an Illness Severity Marker In Emergency Medical Admissions

2020 ◽  
Vol 19 (2) ◽  
pp. 83-89
Author(s):  
Richard Conway ◽  
◽  
Brian O’Connell ◽  
Declan Byrne ◽  
Deirdre O’Riordan ◽  
...  
Keyword(s):  
Blood Culture ◽  
Prognostic Value ◽  
Positive Culture ◽  
Illness Severity ◽  
Blood Cultures ◽  
Multivariable Logistic Regression Model ◽  
Negative Culture ◽  
Culture Performance ◽  
Culture Positive ◽  
Culture Negative

Background: Positive blood cultures predict mortality. The prognostic value of blood culture performance itself has not been fully defined. Methods: We evaluated medical admissions from 2002-2017. We defined blood culture category as 1) no culture 2) negative culture 3) positive culture. We employed a multivariable logistic regression model to evaluate outcomes. Results: We evaluated 78,568 blood cultures in 106,586 admissions. 30-day in-hospital mortality for no culture was 2.8% (95%CI 2.7, 2.9), culture negative 8.9% (95%CI 8.5, 9.3) and culture positive 16.7% (95%CI 15.5, 17.9). There was significant interaction between blood culture category and illness severity, OR 1.06 (95%CI 1.05, 1.08), and comorbidity, OR 1.09 (95%CI 1.09, 1.10). Conclusion: Performance and results of blood cultures are independently associated with increased mortality.

scholarly journals Surgical treatment of infective endocarditis in intravenous drug abusers

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Alina Zubarevich ◽  
Marcin Szczechowicz ◽  
Anja Osswald ◽  
Jerry Easo ◽  
Arian Arjomandi Rad ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Drug Abuse ◽  
Infective Endocarditis ◽  
Mortality Rates ◽  
Blood Cultures ◽  
Intravenous Drug ◽  
Intravenous Drug Abuse ◽  
Enterococcus Species ◽  
Function Impairment

Abstract Background Despite current progress in antibiotic therapy and medical management, infective endocarditis remains a serious condition presenting with high mortality rates. It also is a life-threatening complication in patients with a history of chronic intravenous drug abuse. In this study, we analyzed our institutional experience on the surgical therapy of infective endocarditis in patients with active intravenous drug abuse. The aim of the study is to identify the predictive factors of mortality and morbidity in this subgroup of patients. Methods Between 2007 and 2020, a total of 24 patients (7 female, mean age 38.5 ± 8.7) presenting with active intravenous drug abuse underwent a surgical treatment for the infective endocarditis at out center. The primary endpoint was survival at 30th day after the surgery. The secondary composite endpoint included freedom from death, recurrent endocarditis, re-do surgery, and postoperative stroke during the follow-up period. Mean follow-up was 4.2 ± 4.3 years. Results Staphylococcus species was the most common pathogen detected in the preoperative blood cultures. Infection caused by Enterococcus species as well as liver function impairment were identified as mortality predictor factors. Logistic EuroSCORE and EusoSCORE-II were also predictive factors for mortality in univariate analysis. Survival at 1 and 3 years was 78 and 72% respectively. Thirty-day survival was 88%. 30-day freedom from combined endpoint was 83% and after 1 and 3 years, 69 and 58% of the patients respectively were free from combined endpoint. Five patients (20.8%) were readmitted with recurrent infective endocarditis. Conclusion In patients presenting with active intravenous drug abuse, treatment of infective endocarditis should be performed as aggressively as possible and should be followed by antibiotic therapy to avoid high mortality rates and recurrent endocarditis. Early intervention is advisable in patients with an infective endocarditis and enterococcus species in the preoperative blood cultures, liver function deterioration as well as cardiac function impairment. Attention should be also payed to addiction treatment, due to the elevated relapse rate in patients who actively inject drugs. However, larger prospective studies are necessary to support our results. As septic shock is the most frequent cause of death, new treatment options, e.g. blood purification should be evaluated.

scholarly journals Culture-negative versus culture-positive in pyogenic spondylitis and analysis of risk factors for relapse

2021 ◽  
pp. 1-5
Author(s):  
Guohua Dai ◽  
Shuzhong Li ◽  
Chuqiang Yin ◽  
Yuanliang Sun ◽  
Jianwen Hou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pyogenic Spondylitis ◽  
Culture Positive ◽  
Culture Negative

scholarly journals 1341. Blood Volume Collected for Blood Cultures in Infants with Suspected Neonatal Sepsis in the NICU

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S682-S682
Author(s):  
Maria S Rueda Altez ◽  
Lamia Soghier ◽  
Joseph M Campos ◽  
James Bost ◽  
Jiaxiang Gai ◽  
...  
Keyword(s):  
Bloodstream Infection ◽  
Blood Volume ◽  
Bloodstream Infections ◽  
Blood Cultures ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Volume Calculation ◽  
Culture Negative ◽  
Time Of Collection ◽  
Rule Out

Abstract Background Blood cultures have high sensitivity to detect bacteremia in septic neonates when &gt;=1 ml of blood is collected. Neonatologists often cite low confidence in microbiologic sampling as rationale for continuing antibiotics without a focus of infection despite negative blood cultures, resulting in prolonged antimicrobial therapy. We aim to describe the blood culture sample volumes in NICU patients, to identify factors associated with sample volumes &lt; 1ml, and to compare the sample volumes of patients treated for culture-negative sepsis with those with bloodstream infections and those treated for a ≤72-hour sepsis rule-out Methods Data from this observational cohort study were collected retrospectively and prospectively from NICU patients with blood cultures obtained from September 2018 to February 2019. Clinical data were collected through chart review. All inoculated culture bottles were weighed for volume calculation. We determined the association of age, weight, sample source, and time of collection with volume &lt; 1mL. Continuous variables were analyzed using Wilcoxon-Mann-Whitney, and categorical variables using chi-squared test. For aim 3, the volumes of the groups were compared using analysis of variance. Results A total of 310 blood cultures were identified, corresponding to 159 patients. Of these, 49 (16%) were positive. Among the negative blood cultures, 86% were collected in patients who subsequently received antibiotics (Figure 1). Median inoculated volume was 0.6 ml (IQR: 0.1-2.4). Weight and age at time of culture collection, source of sample, and time of collection were not significantly associated with the inoculation of &lt; 1ml of blood. Median volume of blood was 0.6ml (0.3-0.6) for sepsis rule-out, 0.6ml (0.2-0.6) for bloodstream infection, and 0.6ml (0.6-1.4) for culture-negative sepsis. No difference was found among the three groups (p=0.54) Figure 1. Classification of blood cultures identified during study period Conclusion The blood volume collected for cultures in the NICU is lower than recommended. Clinical and environmental characteristics are not significantly associated with the inoculated volume. The volume of blood sampled does not differ in patients with culture-negative sepsis, bloodstream infection and sepsis rule-out, and should not be a justification for longer duration of antibiotic therapy Disclosures All Authors: No reported disclosures

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