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

Abstract Objectives This study aims to compare and analyze the clinical features, diagnosis, treatment and prognosis of culture-negative and culture-positive primary pyogenic spondylitis. Methods A retrospective analysis of 202 cases of adult primary pyogenic spondylitis with complete clinical data in our hospital from January 2013 to January 2020 were divided into 2 groups according to the bacterial culture results: culture negative group (n = 126), culture Positive group (n = 76). Compare the clinical characteristics, diagnosis, treatment and prognosis of patients with different culture results. Results The culture positive rate was 37.62% (76/202). There were no significant differences in age, gender, affected segment, spinal abscess, diabetes mellitus, course of disease, surgery, recurrence, and follow-up time between the two groups (P > 0.05). Two groups of hospital admission erythrocyte sedimentation rate (erythrocyte sedimentation rate, ESR), admission C-reactive protein (C-reactive protein, CRP), admission white blood cell count (white blood cell, WBC), discharge ESR, discharge CRP, ESR decline rate, CRP There were statistically significant differences in the rate of decline, hospitalization days, and body temperature ≥ 38 °C (P < 0.05). Higher CRP levels on admission, antibiotic treatment time < 6 weeks, and body temperature ≥ 38 ℃ are independent risk factors for infection recurrence. Conclusion The culture-negative group's admission WBC, admission ESR, admission CRP, discharge ESR, discharge CRP, ESR decline rate, CRP decline rate, and hospital stay were lower than the culture positive group, the difference was statistically significant (P < 0.05). The independent risk factors for infection recurrence are higher CRP levels in hospital admission, antibiotic treatment time < 6 weeks, and body temperature ≥ 38 °C.

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Neonatal Sepsis-Culture Positive Sepsis Vs Clinical Sepsis

International Journal of Medical and Dental Sciences ◽

10.18311/ijmds/2017/18790 ◽

2017 ◽

Vol 6 (1) ◽

pp. 1362

Author(s):

Purbasha Ghosh ◽

Rabindra Nath Misra ◽

Retina Paul

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Blood Culture ◽

Neonatal Sepsis ◽

Gold Standard ◽

Methicillin Resistance ◽

High Morbidity ◽

Sepsis Screen ◽

Culture Positive ◽

Culture Negative

Background: The incidence of sepsis is increasing globally, with high morbidity and mortality. Diagnosis of neonatal sepsis is still a clinical and laboratory challenge. Though blood culture is gold standard, it sometimes gives false negative result. So, judgement of clinical condition along with various investigations is important.Objectives: To find out the risk factors associated with neonatal sepsis, to isolate&amp;identify the pathogens from various clinical specimens and to find out antimicrobial susceptibility of the pathogens.Material and methods: Blood culture, sepsis screen, haematological&amp;biochemical markers, cerebrospinal fluid (CSF) study, radiology, MRSA (methicillin resistance Staphylococcus aureus) surveillance were carried out in this study. Some samples were processed in BacT/ALERT-3D system (BioMerieux ) and identified by VITEK-2 (BioMerieux). Epi Info Software system was used to calculate statistics.Results: One seventy (65.9%) were culture positive and 88 (34.1%) were culture negative out of 258 clinically suspected cases. Methicillin sensitive Staphylococcus aureus (MSSA) 66 (38.82%) was the commonest organism. Among 88 culture negative cases, 38(43.2%) babies were two or more sepsis screen tests positive, 40(45.5%) culture negative babies were with risk factors and 5(5.7%) had radiological evidence of pneumonia.Conclusion: The clinical diagnosis of it remains difficult as the symptoms are nonspecific. So, blood culture is mandatory. Other diagnostic tests also help in this situation. Blood culture is still the "Gold standard" for the diagnosis of septicaemia in neonates, but culture negativity cannot exclude the sepsis as a whole.

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Clinical Characteristics and Risk Factors for Culture-Negative Periprosthetic Joint Infections

10.21203/rs.3.rs-67752/v3 ◽

2021 ◽

Author(s):

Shintaro Watanabe ◽

Naomi Kobayashi ◽

Akito Tomoyama ◽

Hyonmin Choe ◽

Etsuko Yamazaki ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Clinical Characteristics ◽

Treatment Success ◽

Multivariate Logistic Regression Analysis ◽

Joint Infections ◽

Wbc Count ◽

Culture Positive ◽

Culture Negative ◽

Low Serum

Abstract Background Culture-negative periprosthetic joint infections (PJIs) can complicate diagnosis and management of PJI. This study aimed to identify risk factors for culture-negative PJI and differences in clinical characteristics between culture-positive and culture-negative PJI group. Methods This retrospective, cross-sectional study evaluated PJI cases obtained between January 2013 and October 2019 at our institution. These PJI cases were divided into culture-positive and culture-negative groups and then compared. The demographics, laboratory findings, and details of patient’s clinical characteristics were investigated. Univariate and multivariate logistic regression analysis were performed to investigate risk factors for culture-negative PJI. Results A total of 109 PJI cases were included in the analysis: 82 (75%) culture-positive and 27 (25%) culture-negative. The mean serum white blood cell (WBC) count, C-reactive protein level, erythrocyte sedimentation rate in the culture-negative group were significantly lower than those in the culture-positive group (p < 0.05). There were no significant differences between the two groups regarding history of prior antibacterial administration or treatment success rates. Multivariate analysis identified a low serum WBC count as a risk factor for culture-negative PJI (odds ratio = 0.78; 95% confidence interval [CI] = 0.63–0.97; p = 0.027). Conclusions A low serum WBC count is a risk factor for culture-negative PJI, but prior antimicrobial therapy is not. The results suggest that PJI cases with lower levels of systemic inflammation are likely to be culture-negative; therefore, the possibility of a culture-negative result should be considered in suspected cases of PJI with low inflammatory markers, regardless of prior antibiotic exposure.

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Clinical characteristics and risk factors for culture-negative periprosthetic joint infections

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02450-1 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Shintaro Watanabe ◽

Naomi Kobayashi ◽

Akito Tomoyama ◽

Hyonmin Choe ◽

Etsuko Yamazaki ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Clinical Characteristics ◽

Treatment Success ◽

Multivariate Logistic Regression Analysis ◽

Joint Infections ◽

Wbc Count ◽

Culture Positive ◽

Culture Negative ◽

Low Serum

Abstract Background Culture-negative periprosthetic joint infections (PJIs) can complicate diagnosis and management of PJI. This study aimed to identify risk factors for culture-negative PJI and differences in clinical characteristics between culture-positive and culture-negative PJI group. Methods This retrospective, cross-sectional study evaluated PJI cases obtained between January 2013 and October 2019 at our institution. These PJI cases were divided into culture-positive and culture-negative groups and then compared. The demographics, laboratory findings, and details of patient’s clinical characteristics were investigated. Univariate and multivariate logistic regression analysis were performed to investigate risk factors for culture-negative PJI. Results A total of 109 PJI cases were included in the analysis: 82 (75%) culture-positive and 27 (25%) culture-negative. The mean serum white blood cell (WBC) count, C-reactive protein level, and erythrocyte sedimentation rate in the culture-negative group were significantly lower than those in the culture-positive group (p < 0.05). There were no significant differences between the two groups regarding history of prior antibacterial administration or treatment success rates. Multivariate analysis identified a low serum WBC count as a risk factor for culture-negative PJI (odds ratio = 0.78; 95% confidence interval [CI] = 0.63–0.97; p = 0.027). Conclusions A low serum WBC count is a risk factor for culture-negative PJI, but prior antimicrobial therapy is not. The results suggest that PJI cases with lower levels of systemic inflammation are likely to be culture-negative; therefore, the possibility of a culture-negative result should be considered in suspected cases of PJI with low inflammatory markers, regardless of prior antibiotic exposure.

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Clinical Characteristics and Risk Factors for Culture-Negative Periprosthetic Joint Infections

10.21203/rs.3.rs-67752/v2 ◽

2020 ◽

Author(s):

Shintaro Watanabe ◽

Naomi Kobayashi ◽

Akito Tomoyama ◽

Hyonmin Choe ◽

Etsuko Yamazaki ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Clinical Characteristics ◽

Treatment Success ◽

Multivariate Logistic Regression Analysis ◽

Lower Serum ◽

Joint Infections ◽

Wbc Count ◽

Culture Positive ◽

Culture Negative

Abstract Background: Culture-negative periprosthetic joint infections (PJIs) can complicate diagnosis and management of PJI. This study aimed to identify risk factors for culture-negative PJI and differences in clinical characteristics between culture-positive and culture-negative PJI group. Methods: This retrospective, cross-sectional study evaluated PJI cases obtained between January 2013 and October 2019 at our institution. These PJI cases were divided into culture-positive and culture-negative groups and then compared. The demographics, laboratory findings, and details of patient’s clinical characteristics were investigated. Univariate and multivariate logistic regression analysis were performed to investigate risk factors for culture-negative PJI.Results: A total of 109 PJI cases were included in the analysis: 82 (75%) culture-positive and 27 (25%) culture-negative. The mean serum white blood cell (WBC) count, C-reactive protein level, erythrocyte sedimentation rate in the culture-negative group were significantly lower than those in the culture-positive group (p < 0.05). There were no significant differences between the two groups regarding history of prior antibacterial administration or treatment success rates. Multivariate analysis identified a lower serum WBC count as a risk factor for culture-negative PJI (odds ratio = 0.78; 95% confidence interval [CI] = 0.63–0.97; p = 0.027).Conclusions: A lower serum WBC count is a risk factor for culture-negative PJI, but prior antimicrobial therapy is not. The results suggest that PJI cases with lower levels of systemic inflammation are likely to be culture-negative; therefore, the possibility of a culture-negative result should be considered in suspected cases of PJI with low inflammatory markers, regardless of prior antibiotic exposure.

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Clinical Characteristics and Risk Factors for Culture-Negative Periprosthetic Joint Infections

10.21203/rs.3.rs-67752/v1 ◽

2020 ◽

Author(s):

Shintaro Watanabe ◽

Naomi Kobayashi ◽

Akito Tomoyama ◽

Hyonmin Choe ◽

Etsuko Yamazaki ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Clinical Characteristics ◽

Treatment Success ◽

Multivariate Logistic Regression Analysis ◽

Joint Infections ◽

Wbc Count ◽

Culture Positive ◽

Culture Negative ◽

Low Serum

Abstract Background: Culture-negative periprosthetic joint infections (PJIs) can complicate diagnosis and management of PJI. This study aimed to identify risk factors for culture-negative PJI and differences in clinical characteristics between culture-positive and culture-negative PJI group. Methods: This retrospective, cross-sectional study evaluated PJI cases obtained between January 2013 and October 2019 at our institution. These PJI cases were divided into culture-positive and culture-negative groups and then compared. The demographics, laboratory findings, and details of patient’s clinical characteristics were investigated. Univariate and multivariate logistic regression analysis were performed to investigate risk factors for culture-negative PJI.Results: A total of 109 PJI cases were included in the analysis: 82 (75%) culture-positive and 27 (25%) culture-negative. The mean serum white blood cell (WBC) count, C-reactive protein level, erythrocyte sedimentation rate in the culture-negative group were significantly lower than those in the culture-positive group (p < 0.05). There were no significant differences between the two groups regarding history of prior antibacterial administration or treatment success rates. Multivariate analysis identified a low serum WBC count as a risk factor for culture-negative PJI (odds ratio = 0.78; 95% confidence interval [CI] = 0.63–0.97; p = 0.027).Conclusions: A low serum WBC count is a risk factor for culture-negative PJI, but prior antimicrobial therapy is not. The results suggest that PJI cases with lower levels of systemic inflammation are likely to be culture-negative; therefore, the possibility of a culture-negative result should be considered in suspected cases of PJI with low inflammatory markers, regardless of prior antibiotic exposure.

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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.

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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.

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Evaluation of the performance of clinical predictors in estimating the probability of pulmonary tuberculosis among smear-negative cases in Northern Ethiopia: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2020-037913 ◽

2020 ◽

Vol 10 (11) ◽

pp. e037913

Author(s):

Mala George ◽

Geert-Jan Dinant ◽

Efrem Kentiba ◽

Teklu Teshome ◽

Abinet Teshome ◽

...

Keyword(s):

Pulmonary Tuberculosis ◽

Cross Sectional Study ◽

Clinical Suspicion ◽

Secondary Outcome ◽

Northern Ethiopia ◽

Sectional Study ◽

Cross Sectional ◽

Smear Negative ◽

Culture Positive ◽

Culture Negative

ObjectivesTo evaluate the performance of the predictors in estimating the probability of pulmonary tuberculosis (PTB) when all versus only significant variables are combined into a decision model (1) among all clinical suspects and (2) among smear-negative cases based on the results of culture tests.DesignA cross-sectional study.SettingTwo public referral hospitals in Tigray, Ethiopia.ParticipantsA total of 426 consecutive adult patients admitted to the hospitals with clinical suspicion of PTB were screened by sputum smear microscopy and chest radiograph (chest X-ray (CXR)) in accordance with the Ethiopian guidelines of the National Tuberculosis and Leprosy Program. Discontinuation of antituberculosis therapy in the past 3 months, unproductive cough, HIV positivity and unwillingness to give written informed consent were the basis of exclusion from the study.Primary and secondary outcome measuresA total of 354 patients were included in the final analysis, while 72 patients were excluded because culture tests were not done.ResultsThe strongest predictive variables of culture-positive PTB among patients with clinical suspicion were a positive smear test (OR 172; 95% CI 23.23 to 1273.54) and having CXR lesions compatible with PTB (OR 10.401; 95% CI 5.862 to 18.454). The regression model had a good predictive performance for identifying culture-positive PTB among patients with clinical suspicion (area under the curve (AUC) 0.84), but it was rather poor in patients with a negative smear result (AUC 0.64). Combining all the predictors in the model compared with only the independent significant variables did not really improve its performance to identify culture-positive (AUC 0.84–0.87) and culture-negative (AUC 0.64–0.69) PTB.ConclusionsOur finding suggests that predictive models based on clinical variables will not be useful to discriminate patients with culture-negative PTB from patients with culture-positive PTB among patients with smear-negative cases.

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Circulating microbial cell-free DNA is associated with inflammatory host-responses in severe pneumonia

Thorax ◽

10.1136/thoraxjnl-2020-216013 ◽

2021 ◽

pp. thoraxjnl-2020-216013

Author(s):

Haopu Yang ◽

Ghady Haidar ◽

Nameer S Al-Yousif ◽

Haris Zia ◽

Daniel Kotok ◽

...

Keyword(s):

Large Scale ◽

Inflammatory Responses ◽

Severe Pneumonia ◽

Systemic Circulation ◽

Microbial Cell ◽

Metagenomic Sequencing ◽

Cell Free Dna ◽

Free Dna ◽

Culture Positive ◽

Culture Negative

Host inflammatory responses predict worse outcome in severe pneumonia, yet little is known about what drives dysregulated inflammation. We performed metagenomic sequencing of microbial cell-free DNA (mcfDNA) in 83 mechanically ventilated patients (26 culture-positive, 41 culture-negative pneumonia, 16 uninfected controls). Culture-positive patients had higher levels of mcfDNA than those with culture-negative pneumonia and uninfected controls (p<0.005). Plasma levels of inflammatory biomarkers (fractalkine, procalcitonin, pentraxin-3 and suppression of tumorigenicity-2) were independently associated with mcfDNA levels (adjusted p<0.05) among all patients with pneumonia. Such host–microbe interactions in the systemic circulation of patients with severe pneumonia warrant further large-scale clinical and mechanistic investigations.

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