Abstract
BackgroundSepsis remains one of the most important causes of morbidity and mortality worldwide. In approximately 30–50% of cases of suspected sepsis, no pathogen is isolated, disabling the clinician to treat the patient with targeted antimicrobial therapy. Studies investigating the differences in the patient outcomes between culture-positive and culture-negative sepsis patients have only been conducted in subgroups of sepsis patients and results are ambiguous.MethodsThis is a sub-analysis of the PHANTASi (Prehospital Antibiotics Against Sepsis trial), a randomized controlled trial that focused on the effect of prehospital antibiotics in sepsis patients. We evaluated the outcome of cultures from different sources and determined what the clinical implications of having a positive culture compared to negative cultures were for patient outcomes. Furthermore, we looked at the effect of antibiotics on culture outcomes.Results1133 patients (42.6%) with culture-positive sepsis were identified, compared to 1526 (56.4%) patients with culture-negative sepsis.28-day mortality (RR 1.43 [95% CI 1.11–1.83]) and 90-day mortality (RR 1.41 [95% CI 1.15–1.71]) were significantly higher in culture-positive patients compared to culture-negative patients.Culture-positive sepsis was also associated with ≥ 3 organ systems affected during the sepsis episode (RR 4.27 [95% CI 2.78–6.60]). Patients who received antibiotics at home more often had negative blood cultures (85.9% vs. 78%) than those who did not (p < 0.001).ConclusionsOur results show that culture-positive sepsis is associated with a higher mortality rate and culture-positive patients more often have multiple organ systems affected during the sepsis episode.Trial registrationThe PHANTASi trial is registered at ClinicalTrials.gov, number NCT01988428. Date of registration: November 20, 2013.
Highlights
Sepsis remains one of the most important causes of morbidity and mortality worldwide
The secondary aims of this study were to describe the association between the administration of pre-hospital antibiotics (2 g ceftriaxone in the ambulance) and mortality in culture-positive sepsis patients as well as describing the different specimen sources identified in the various types of cultures
The PHANTASi trial was a randomized controlled trial that compared the effects of training (EMS) personnel in recognizing and initiating treatment in the prehospital setting together with early administration of antibiotics for patients suspected of sepsis and septic shock when compared to usual care
Summary
Sepsis remains one of the most important causes of morbidity and mortality worldwide. Mortality rates have been decreasing, the incidence of sepsis continues to increase [2]. This is due to several factors, among which are as follows: an aging population, antibiotic resistance, improved recognition of sepsis, and use of immunotherapy [2, 3]. One of the cornerstones of the diagnosis and treatment of sepsis is the collection of (blood) cultures. This is of importance since detection of the organism that caused sepsis provides possibilities for targeted antimicrobial therapy [1]. Bernard et al [5] found a negative blood culture in approximately 68% of cases with severe sepsis
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