Abstract
BackgroundThe long-term outcome is an essential issue in critically ill patients, and the identification of early determinant is needed for risk stratification of the long-term outcome. In the present study, we investigate the association between culture positivity during admission and long-term outcome in critically ill surgical patients.MethodsWe linked the 2015–2019 critical care database at Taichung Veterans General Hospital with the nationwide death registration files in Taiwan. We described the long-term mortality and proportion of culture positivity among enrolled subjects. We used a log-rank test to estimate survival curves between patients with and without positive cultures and a multivariable Cox proportional hazards regression model to determine hazard ratio (HR) and 95% confidence interval (CI).ResultsA total of 6748 critically ill patients were enrolled, and 32.5% (2196/6749) of them died during the follow-up period, with the overall follow-up duration was 1.8 ± 1.4 years. We found that 31.4% (2122/6748) of critically ill patients had at least one positive culture during the index admission, and the number of patients with positive culture in the blood, respiratory tract, urinary tract, skin and soft tissue and abdomen were 417, 1702, 554, 194 and 139, respectively. We found that a positive culture from any sites was independently associated with high long-term mortality (aHR 1.579, 95% CI 1.422–1.754) after adjusting relevant covariates, including age, sex, body-mass index, comorbidities, severity score, shock, early fluid overload, receiving mechanical ventilation and the need of renal replacement therapy for critical illness.ConclusionsWe linked two databases to identify that a positive culture during admission was independently correlated with increased long-term mortality in critically ill surgical patients. Our findings highlight the need for vigilance among patients with a positive culture during admission, and more studies are warranted to validate our findings and to clarify underlying mechanisms.
Highlights
The long-term outcome is an essential issue in critically ill patients, and the identification of early deter‐ minant is needed for risk stratification of the long-term outcome
Main pathogens among critically ill surgical patients We found that 31.4% (2122/6748) of critically ill patients had at least one positive culture during the index admission, and the number of patients with positive culture in the blood, respiratory tract, urinary tract, skin and soft tissue and abdomen were 417, 1702, 554, 194 and 139, respectively (Table 2)
Fungal infection is increasingly a crucial issue among critically ill patients worldwide [21], and we found that 6.4% (435/6748) of critically ill surgical patients had positive fungal culture, with Candida albicans (n = 238, 54.7%) accounted for the majority of positive fungal culture, followed by Candida
Summary
The long-term outcome is an essential issue in critically ill patients, and the identification of early deter‐ minant is needed for risk stratification of the long-term outcome. Increasing evidence have shown the crucial role of chronic critical illness (CCI), characterised by persistent organ dysfunction, vulnerability for secondary infection, prolonged ICU course and high resource utilisation after discharge, among critically ill surgical patients [7]. A number of studies have demonstrated the critical illnessassociated prolonged microbial alternation among critically ill surgical patients [8,9,10]. One recent study further characterised CCI with the prolonged immunological and metabolic alternation in 144 critically ill surgical patients with abdominal infection [11]. These data highlight the need to identify early determinants, microbial factors, of the long-term outcome in surgical patients requiring intensive care
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