Comparison of Clinical Characteristics and Outcomes Between Positive and Negative Blood Culture Septic Patients: A Retrospective Cohort Study

Abstract

Background

Few studies have studied the relationship between blood culture and mortality in sepsis patients. The aim of this study was to compare the characteristics and outcomes of positive and negative blood culture sepsis.

Methods

We performed a study on 640 patients suffering from sepsis in Beijing Chao-Yang Hospital from October 2017 to December 2019. The primary findings revolved around length and expenditure of hospital stay, the possibility of suffering from acute respiratory distress syndrome (ARDS), and any requirements for mechanical ventilation. The secondary findings revolved around whether the patient died early (28-day) or late (28-to-90-day).

Results

A total of 592 of the 640 patients met the inclusion criteria for sepsis, with 274 of them having culture-positive results. The culture-positive patients were mostly elderly suffering from diabetes and at risk of cancer, with a higher white blood cell count, and higher procalcitonin. Additionally, they scored higher in their acute physiology and chronic health evaluation II score (15 vs.11, P=0.010), as well as in their predisposition, infection, response, and organ dysfunction (17 vs 11, P<0.001) than the individuals in the culture-negative group. Culture-positive patients had a longer duration of hospital stay (14 vs 6, P<0.001) and higher in-hospital mortality (14.6% vs 8.5%, P=0.019) than culture-negative ones. No significant difference in intensive care unit (ICU) mortality (45.7% vs.36.4%, P=0.254) or early mortality (9.5% vs 7.2%, P=0.321) was noted between the two groups. However, the culture-positive patients had increased late mortality (15.7% vs.6.9%, P=0.001), when compared with those with culture-negative results in the cohort. Furthermore, the culture-positive patients who received the appropriate antibiotics early had a lower mortality rate than the culture-negative patients (7.3% vs.14.2%, P=0.008).

Conclusion

Culture-positive patients had higher in-hospital mortality, comparable early mortality, and worse late mortality than the culture-negative patients. Early appropriate use of antibiotics might reduce mortality and improve clinical prognosis.

Keywords:

• blood culture
• culture-positive
• culture-negative
• sepsis
• antibiotics
• mortality

Acknowledgments

We would like to thank Beijing Chao-Yang Hospital for facilitating the study and covering the data collection costs. We would also like to acknowledge all data collectors, supervisors, and respondents without whom this research would not have been realized.

Abbreviations

ARDS, acute respiratory distress syndrome; ICU, intensive care unit; SOFA, Sequential Organ Failure Assessment; APACHE II, Acute Physiology and Chronic Health Evaluation II; MEDS, Mortality in emergency department sepsis; PIRO, Predisposition, Infection, Response, and Organ dysfunction; CI, confidence interval; COPD, chronic obstructive pulmonary disease; CHF, congestive heart failure; DM, diabetes mellitus; CVD, cerebrovascular disease; CRD, chronic renal disease; MBP, mean blood pressure; WBC, white blood cells; CRP, C-reactive proteins; PCT, procalcitonin; ALB, albumin; ED, Emergency Department; Lac, lactate; PLT, platelet.

Highlights

• Studies on the comparison of characteristics and outcomes between positive and negative blood culture septic patients are rare. Our research provides guidance for reducing mortality and improving clinical prognosis.

• The distribution and characteristics of pathogenic bacteria in different areas of the hospital may be helpful for prescribing appropriate antibiotics.

• A forest plot was drawn to facilitate intuitive research for culture-positive and culture-negative patients which has rarely been seen before.

Data Sharing Statement

The dataset that was used to support the finding of this study will be made available from the corresponding author upon reasonable request.

Ethics Approval and Consent to Participant

This study was approved by the Institutional Review Board of affiliated hospital of Capital Medical University, Beijing, China (CCMU-R2021077) and conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that there are no conflicts of interest regarding this work.