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Culture-Negative Septic Shock Compared With Culture-Positive Septic Shock: A Retrospective Cohort Study.
Crit Care Med. 2018 Jan 02;:
Authors: Kethireddy S, Bilgili B, Sees A, Kirchner HL, Ofoma UR, Light RB, Mirzanejad Y, Maki D, Kumar A, Layon AJ, Parrillo JE, Kumar A, Cooperative Antimicrobial Therapy of Septic Shock (CATSS) Database Research Group
Abstract
OBJECTIVES: To determine the clinical characteristics and outcomes of culture-negative septic shock in comparison with culture-positive septic shock.
DESIGN: Retrospective nested cohort study.
SETTING: ICUs of 28 academic and community hospitals in three countries between 1997 and 2010.
SUBJECTS: Patients with culture-negative septic shock and culture-positive septic shock derived from a trinational (n = 8,670) database of patients with septic shock.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Patients with culture-negative septic shock (n = 2,651; 30.6%) and culture-positive septic shock (n = 6,019; 69.4%) were identified. Culture-negative septic shock compared with culture-positive septic shock patients experienced similar ICU survival (58.3% vs 59.5%; p = 0.276) and overall hospital survival (47.3% vs 47.1%; p = 0.976). Severity of illness was similar between culture-negative septic shock and culture-positive septic shock groups ([mean and SD Acute Physiology and Chronic Health Evaluation II, 25.7 ± 8.3 vs 25.7 ± 8.1]; p = 0.723) as were serum lactate levels (3.0 [interquartile range, 1.7-6.1] vs 3.2 mmol/L [interquartile range, 1.8-5.9 mmol/L]; p = 0.366). As delays in the administration of appropriate antimicrobial therapy after the onset of hypotension increased, patients in both groups experienced congruent increases in overall hospital mortality: culture-negative septic shock (odds ratio, 1.56; 95% CI [1.47-1.66]; p < 0.0001) and culture-positive septic shock (odds ratio, 1.65; 95% CI [1.59-1.71]; p < 0.0001).
CONCLUSIONS: Patients with culture-negative septic shock behave similarly to those with culture-positive septic shock in nearly all respects; early appropriate antimicrobial therapy appears to improve mortality. Early recognition and eradication of infection is the most obvious effective strategy to improve hospital survival.
PMID: 29293143 [PubMed - as supplied by publisher]