scholarly journals Culture-negative and culture-positive septic shock: characteristics and clinical outcomes

2020 ◽  
Author(s):  
June-sung Kim ◽  
Youn-Jung Kim ◽  
Won Young Kim
Keyword(s):  
Septic Shock ◽  
Respiratory Tract ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Clinical Outcomes ◽  
Lower Respiratory Tract ◽  
Detection Time ◽  
Failure Assessment ◽  
Culture Positive ◽  
Culture Negative

Abstract Background We evaluated the characteristics and outcomes of culture-negative septic shock versus culture-positive septic shock.Methods We performed a retrospective observational study of data from a prospective registry from 2014 to 2018. A total of 2,499 adult patients with septic shock were enrolled. The primary outcome was 90-day mortality, and the secondary outcomes were the length of hospital stay, a requirement for mechanical ventilation or renal replacement therapy, and in-hospital mortality.Results Of 1,718 patients with septic shock, 1,012 (58.9%) patients were culture-positive (blood 803, urine 302, sputum 102, others 204) and the median pathogen detection time was 9.5 hours (aerobic 10.2 hours and anaerobic 9.0 hours). The most common site of infection among the culture-positive was the hepatobiliary tract (39.5%), while for the culture-negative was the lower respiratory tract (38.2%). The culture-negative group had a lower mean body temperature (37.3 vs 37.7 ℃), lactate (2.5 vs. 3.2 mmol/L), C-reactive protein (11.1 vs 11.9 mg/dL), and sequential organ failure assessment score (7.0 vs. 8.0) than that of the culture-positive group. However, 90-day mortality between the groups was not significantly different (32.7 vs 32.2%, p = 0.83), and the other clinical outcomes also did not differ significantly. Moreover, a shorter culture detection time was correlated with a higher sequential organ failure assessment score but not with mortality.Conclusion Patients with septic shock are frequently culture-negative, especially in cases where the infection focus is in the lower respiratory tract. Although culture-negative was associated with degree of organ dysfunction, it was not an independent predictor of death.

scholarly journals Characteristics and clinical outcomes of culture-negative and culture-positive septic shock: a single-center retrospective cohort study

2020 ◽  
Author(s):  
June-sung Kim ◽  
Youn-Jung Kim ◽  
Won Young Kim
Keyword(s):  
Septic Shock ◽  
Respiratory Tract ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Clinical Outcomes ◽  
Lower Respiratory Tract ◽  
Detection Time ◽  
Failure Assessment ◽  
Culture Positive ◽  
Culture Negative

Abstract Background: We evaluated the characteristics and outcomes of culture-negative septic shock versus culture-positive septic shock.Methods: We performed a retrospective observational study of data from a prospective registry from 2014 to 2018. A total of 2,499 adult patients with septic shock were enrolled. The primary outcome was 90-day mortality, and the secondary outcomes were the length of hospital stay, a requirement for mechanical ventilation or renal replacement therapy, and in-hospital mortality.Results: Of 1,718 patients with septic shock, 1,012 (58.9%) patients were culture-positive (blood 803, urine 302, sputum 102, others 204) and the median pathogen detection time was 9.5 hours (aerobic 10.2 hours and anaerobic 9.0 hours). The most common site of infection among the culture-positive was the hepatobiliary tract (39.5%), while for the culture-negative was the lower respiratory tract (38.2%). The culture-negative group had a lower mean body temperature (37.3 vs 37.7 ℃), lactate (2.5 vs. 3.2 mmol/L), C-reactive protein (11.1 vs 11.9 mg/dL), and sequential organ failure assessment score (7.0 vs. 8.0) than that of the culture-positive group. However, 90-day mortality between the groups was not significantly different (32.7 vs 32.2%, p=0.83), and the other clinical outcomes also did not differ significantly. Moreover, a shorter culture detection time was correlated with a higher sequential organ failure assessment score but not with mortality.Conclusion: Patients with septic shock are frequently culture-negative, especially in cases where the infection focus is in the lower respiratory tract. Although culture-negative was associated with degree of organ dysfunction, it was not an independent predictor of death.

scholarly journals Characteristics and clinical outcomes of culture-negative and culture-positive septic shock: a single-center retrospective cohort study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
June-sung Kim ◽  
Youn-Jung Kim ◽  
Won Young Kim
Keyword(s):  
Septic Shock ◽  
Respiratory Tract ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Clinical Outcomes ◽  
Lower Respiratory Tract ◽  
Detection Time ◽  
Failure Assessment ◽  
Culture Positive ◽  
Culture Negative

Abstract Background We evaluated the characteristics and outcomes of culture-negative versus culture-positive septic shock. Methods We performed a retrospective observational study of data from a prospective registry from 2014 to 2018. A total of 2,499 adult patients with septic shock were enrolled. The primary outcome was 90-day mortality, and the secondary outcomes were the length of hospital stay, a requirement for mechanical ventilation or renal replacement therapy, and in-hospital mortality. Results Of 1,718 patients with septic shock, 1,012 (58.9%) patients were culture-positive (blood 803, urine 302, sputum 102, others 204) and the median pathogen detection time was 9.5 h (aerobic 10.2 h and anaerobic 9.0 h). The most common site of culture-positive infection was the hepatobiliary tract (39.5%), while for the culture-negative it was the lower respiratory tract (38.2%). The culture-negative group had a lower mean body temperature (37.3 vs 37.7 ℃), lactate (2.5 vs. 3.2 mmol/L), C-reactive protein (11.1 vs 11.9 mg/dL), and sequential organ failure assessment score (7.0 vs. 8.0) than that of the culture-positive group. However, 90-day mortality between the groups was not significantly different (32.7 vs 32.2%, p = 0.83), and the other clinical outcomes also did not differ significantly. Moreover, a shorter culture detection time was correlated with a higher sequential organ failure assessment score but not with mortality. Conclusion Patients with septic shock are frequently culture-negative, especially in cases where the infection focus is in the lower respiratory tract. Although culture-negative was associated with a degree of organ dysfunction, it was not an independent predictor of death.

scholarly journals Characteristics and clinical outcomes of culture-negative and culture-positive septic shock: a single-center retrospective cohort study

2020 ◽  
Author(s):  
June-sung Kim ◽  
Youn-Jung Kim ◽  
Won Young Kim
Keyword(s):  
Septic Shock ◽  
Respiratory Tract ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Clinical Outcomes ◽  
Lower Respiratory Tract ◽  
Detection Time ◽  
Failure Assessment ◽  
Culture Positive ◽  
Culture Negative

Abstract Background: We evaluated the characteristics and outcomes of culture-negative septic shock versus culture-positive septic shock.Methods: We performed a retrospective observational study of data from a prospective registry from 2014 to 2018. A total of 2,499 adult patients with septic shock were enrolled. The primary outcome was 90-day mortality, and the secondary outcomes were the length of hospital stay, a requirement for mechanical ventilation or renal replacement therapy, and in-hospital mortality.Results: Of 1,718 patients with septic shock, 1,012 (58.9%) patients were culture-positive (blood 803, urine 302, sputum 102, others 204) and the median pathogen detection time was 9.5 hours (aerobic 10.2 hours and anaerobic 9.0 hours). The most common site of infection among the culture-positive was the hepatobiliary tract (39.5%), while for the culture-negative was the lower respiratory tract (38.2%). The culture-negative group had a lower mean body temperature (37.3 vs 37.7 ℃), lactate (2.5 vs. 3.2 mmol/L), C-reactive protein (11.1 vs 11.9 mg/dL), and sequential organ failure assessment score (7.0 vs. 8.0) than that of the culture-positive group. However, 90-day mortality between the groups was not significantly different (32.7 vs 32.2%, p=0.83), and the other clinical outcomes also did not differ significantly. Moreover, a shorter culture detection time was correlated with a higher sequential organ failure assessment score but not with mortality.Conclusion: Patients with septic shock are frequently culture-negative, especially in cases where the infection focus is in the lower respiratory tract. Although culture-negative was associated with degree of organ dysfunction, it was not an independent predictor of death.

scholarly journals Characteristics and clinical outcomes of culture-negative and culture-positive septic shock: a single-center retrospective cohort study

2020 ◽  
Author(s):  
June-sung Kim ◽  
Youn-Jung Kim ◽  
Won Young Kim
Keyword(s):  
Septic Shock ◽  
Respiratory Tract ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Clinical Outcomes ◽  
Lower Respiratory Tract ◽  
Detection Time ◽  
Failure Assessment ◽  
Culture Positive ◽  
Culture Negative

Abstract Background: We evaluated the characteristics and outcomes of culture-negative versus culture-positive septic shock.Methods: We performed a retrospective observational study of data from a prospective registry from 2014 to 2018. A total of 2,499 adult patients with septic shock were enrolled. The primary outcome was 90-day mortality, and the secondary outcomes were the length of hospital stay, a requirement for mechanical ventilation or renal replacement therapy, and in-hospital mortality.Results: Of 1,718 patients with septic shock, 1,012 (58.9%) patients were culture-positive (blood 803, urine 302, sputum 102, others 204) and the median pathogen detection time was 9.5 hours (aerobic 10.2 hours and anaerobic 9.0 hours). The most common site of culture-positive infection was the hepatobiliary tract (39.5%), while for the culture-negative it was the lower respiratory tract (38.2%). The culture-negative group had a lower mean body temperature (37.3 vs 37.7 ℃), lactate (2.5 vs. 3.2 mmol/L), C-reactive protein (11.1 vs 11.9 mg/dL), and sequential organ failure assessment score (7.0 vs. 8.0) than that of the culture-positive group. However, 90-day mortality between the groups was not significantly different (32.7 vs 32.2%, p=0.83), and the other clinical outcomes also did not differ significantly. Moreover, a shorter culture detection time was correlated with a higher sequential organ failure assessment score but not with mortality.Conclusion: Patients with septic shock are frequently culture-negative, especially in cases where the infection focus is in the lower respiratory tract. Although culture-negative was associated with a degree of organ dysfunction, it was not an independent predictor of death.

The Association Between Sequential Organ Failure Assessment Scores and Mortality in Patients With Sepsis During the First Week: The JSEPTIC DIC Study

2018 ◽  
Vol 35 (7) ◽  
pp. 656-662 ◽  
Author(s):  
Tsuyoshi Nakashima ◽  
Kyohei Miyamoto ◽  
Toshio Shimokawa ◽  
Seiya Kato ◽  
Mineji Hayakawa
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Hospital Mortality ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Sofa Score ◽  
Assessment Scores ◽  
Coagulation Study ◽  
Failure Assessment ◽  
The Relationship

Objective: Predicting prognosis is a complex process, particularly in patients with severe sepsis or septic shock. This study aimed to determine the relationship between the Sequential Organ Failure Assessment (SOFA) scores for individual organs during the first week of admission and the in-hospital mortality in patients with sepsis. Methods: This study was a post hoc evaluation of the Japan Septic Disseminated Intravascular Coagulation study and included patients admitted to 42 intensive care units in Japan for severe sepsis or septic shock, between January 2011 and December 2013. We assessed the relationship between the organ and total SOFA scores on days 1, 3, and 7 following admission and the in-hospital mortality using logistic regression analysis. Results: We evaluated 2732 patients and found the in-hospital mortality rate was 29.1%. The mean age of the patients (standard deviation) was 70.5 (14.1) years, and the major primary site of infection was the abdomen (33.6%). The central nervous system (CNS) SOFA score exhibited the strongest relationship with mortality on days 1 (adjusted odds ratio [aOR]: 1.49, 95% confidence interval [CI]: 1.40-1.59), 3 (aOR: 1.75, 95% CI: 1.62-1.89), and 7 (aOR: 1.93, 95% CI: 1.77-2.10). The coagulation SOFA scores showed a weak correlation with mortality on day 1, but a strong correlation with mortality on day 7 (aOR: 2.04, 95% CI: 1.87-2.24). Conclusions: The CNS SOFA scores were associated with mortality in patients with severe sepsis on days 1, 3, and 7 following hospitalization. The coagulation SOFA score was associated with mortality on day 7. In clinical situations, the CNS SOFA scores during the acute phase and the CNS SOFA and coagulation SOFA scores during the subsequent phases should be evaluated in order to determine patient prognosis.

Prognostic evaluation of severe sepsis and septic shock: Procalcitonin clearance vs Δ Sequential Organ Failure Assessment

2015 ◽  
Vol 30 (1) ◽  
pp. 219.e9-219.e12 ◽  
Author(s):  
José R.A. de Azevedo ◽  
Orlando J.M. Torres ◽  
Rafael A. Beraldi ◽  
Carmen A.P.M. Ribas ◽  
Osvaldo Malafaia
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Prognostic Evaluation ◽  
Failure Assessment ◽  
Sepsis And Septic Shock

scholarly journals A preliminary report of clinical experience in managing patients with sepsis and septic shock in emergency medicine ward

2018 ◽  
Vol 26 (1) ◽  
pp. 15-25
Author(s):  
Chun Kit Li ◽  
Oi Fung Wong ◽  
Shing Ko ◽  
Hing Man Ma ◽  
Chau Hung Albert Lit
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Hospital Mortality ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Organ Dysfunction ◽  
Medical Ward ◽  
Factors Associated ◽  
Emergency Medical ◽  
Failure Assessment

Background: Sepsis and septic shock are common causes of hospital admission, morbidity, and mortality, posing a significant burden on the health-care systems. Objective: The objective of this study was to report the clinical experience of management and outcomes of sepsis patients in the emergency medical ward of a community hospital. The risk factors associated with adverse outcomes of sepsis patients were also analyzed. Methods: This was a retrospective cohort study of patients with sepsis or septic shock managed in the emergency medical ward of North Lantau Hospital from 1 March 2015 to 31 March 2017. Their characteristics, clinical outcomes, risk factors associated with in-hospital mortality, 28-day mortality, and prolonged hospital stay (>14 days) were analyzed. Results: A total of 68 eligible patients met the inclusion criteria during the study period. The mean age of the patients was 73 (standard deviation, 16.7; range, 34–100) years. The mean Sequential Organ Failure Assessment score of all the cases was 4.5 (standard deviation, 2.4); range, 2–11). The most common source of infection was pneumonia (50%). During the stay in the emergency medical ward, 35 cases (49%) required vasopressor support for management of septic shock, and 12 cases required non-invasive ventilation (NIV) support. Five patients were eventually transferred to tertiary hospital (Princess Margaret Hospital) for further management. There were five in-hospital mortality cases and two 28-day mortality cases. From the univariate analysis, factors associated with in-hospital mortality included Sequential Organ Failure Assessment score >6 (p < 0.000), increasing number of organ dysfunction (p < 0.000), presence of chronic liver disease (p = 0.025), respiratory dysfunction during admission (p = 0.028); factors associated with 28-day mortality were advanced age (p < 0.000), increasing number of organ dysfunction (p = 0.033), presence of congestive heart failure (p = 0.004), and the presence of cancer (p = 0.034); factors associated with prolonged hospital stay were advanced age, presence of chronic obstructive airway disease (p = 0.003), advanced age (p = 0.041), and the use of NIV support (p = 0.001). In multivariate analysis, weak associations between in-hospital mortality and Sequential Organ Failure Assessment score >6 (p = 0.226) and increased number of organ dysfunction (p = 0.108) were demonstrated; there was a trend of prolonged length of stay with increased age (p = 0.139). Conclusion: Our experience and knowledge in managing sepsis patients in the emergency medical ward with implementation of critical care bed services increased significantly. These preliminary results demonstrated that, with appropriate patient selection, sepsis patients can be safely managed in the emergency medical ward. Further study with larger sample size is needed to identify risk factors of adverse outcomes in this group of patients managed in the emergency medical ward.

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