Abstract
PurposeTo compare the mortality rates between culture-positive and culture-negative sepsis in complicated intra-abdominal infections (cIAI) and investigate the predictors of culture-positivity and their causative microorganisms.Materials and methodsThe medical records of 1581 adult patients who underwent emergency gastrointestinal surgery between January 2013 and December 2018 were reviewed retrospectively. A total of 239 patients with sepsis or septic shock who were admitted to an emergency department, underwent emergency surgery for cIAI, and needed postoperative intensive care unit care were included and divided into two groups according to their initial blood and peritoneal culture results.ResultsAmong the 239 patients, 200 were culture-negative and 39 were culture-positive. The culture-positive group had higher in-hospital (35.9% vs 14.5%; P = .001) and 30-day mortality (30.8% vs 12.0%; P = .003) than the culture-negative group. Colon involvement (OR 4.211; 95% CI 1.909–9.287; P < .001) and higher Sequential Organ Failure Assessment (SOFA) score (OR 1.169; 95% CI 1.065–1.282; P = .001) were shown to be the predictors of culture-positive sepsis for cIAI. Regarding antibiotic sensitivity, 31.6% of the gram-positive bacteria were methicillin-resistant and 42.1% of the gram-negative bacteria were extended spectrum β-lactamase-producing Enterobacteriaceae.ConclusionsPatients with cIAI had higher mortality rates in culture-positive sepsis than in culture-negative sepsis. High SOFA score and colon involvement were the risk factors associated with culture-positivity. The most common single species grown in the blood or peritoneal cultures was Escherichia coli, and the most common group was Gram-positive cocci.
Highlights
Sepsis is one of the most common causes of mortality in hospitalized patients [1, 2]
A third definition of sepsis, Sepsis-3, reestablished sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection, with organ dysfunction represented by an increase in the Sequential Organ Failure Assessment (SOFA) score of 2 points or more [4]
Electronic medical records of 1581 patients who underwent emergency gastrointestinal (GI) surgery for intra-abdominal infection from January 2013 to December 2018 in a tertiary medical center were reviewed. 239 patients with sepsis or septic shock were included for analysis with following inclusion criteria: patients who admitted via emergency department (ED), received no antibiotics prior to the ED admission, required postoperative intensive care unit (ICU) care, and underwent surgery for complicated intra-abdominal infections (cIAI)
Summary
Sepsis is one of the most common causes of mortality in hospitalized patients [1, 2]. From the early 1990s to the middle of 2010s, the definition of sepsis was generally accepted as having systemic inflammatory response with suspected source of infection [3]. A third definition of sepsis, Sepsis-3, reestablished sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection, with organ dysfunction represented by an increase in the Sequential Organ Failure Assessment (SOFA) score of 2 points or more [4]. Several hypotheses have been developed to explain the low yield of detecting microorganisms in these septic patients. These hypotheses include prior antibiotic treatment, insufficient sampling of blood, transport problems, and insufficient technique [9]
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