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Comparison between culture-positive and culture-negative septic shock in patients in the emergency department

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Abstract

Culture results of patients with septic shock affect their management strategies, including antibiotic administration. This study aimed to compare clinical characteristics and outcomes of patients with culture-negative septic shock (CNSS) and culture-positive septic shock (CPSS) in the emergency department. We also assessed the differences in duration and de-escalation timing of antibiotic administration between the two groups. This single-center, retrospective, case–control study included adult patients diagnosed with septic shock in the emergency department between January 1, 2019 and March 31, 2020. They were divided into the CNSS and CPSS groups based on their culture results. The baseline characteristics, infection sites, culture types, and clinical outcomes were recorded and compared. Patients with CPSS (63.7%, 311/488) and CNSS (36.3%, 177/488) were identified. The CPSS and CNSS groups had comparable clinical outcomes, including mechanical ventilation (29.6% vs. 32.8%, p = 0.46), renal replacement therapy (19.3% vs. 23.2%, p = 0.31), 30-day mortality (35.7% vs. 36.7%, p = 0.82), and in-hospital mortality (39.5% vs. 41.8%, p = 0.63). The CNSS group had a significantly shorter duration (13 [8 − 19] vs. 16 [10 − 23], days, p = 0.04) and earlier de-escalation timing (5 [2 − 9] vs. 9 [7 − 12], day, p = 0.02) of antibiotic administration than the CPSS group. Patients with CNSS and CPSS had similar clinical characteristics and proportion of adverse outcomes. Physicians can evaluate the feasibility of early de-escalation or discontinuation of antibiotic administration in patients with CNSS showing clinical improvement.

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Data availability

The datasets used and/or analyzed during the present study are available from the corresponding author upon reasonable request.

Abbreviations

CNSS:

Culture-negative septic shock

CPSS:

Culture-positive septic shock

ED:

Emergency department

MAP:

Mean arterial pressure

qSOFA:

Quick sequential organ failure assessment

SIRS:

Systemic inflammatory response syndrome

SOFA:

Sequential organ failure assessment

ICU:

Intensive care unit

CRP:

C-reactive protein

SD:

Standard deviation

IQR:

Interquartile range

INR:

International normalized ratio

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Author information

Authors and Affiliations

  1. Department of Emergency Medicine, E-Da Hospital, I-Shou University, No.1, Yida Road, Jiao-su Village, Yan-chao District, Kaohsiung, 82445, Taiwan

    Choon-Bing Chua, Chi-Chieh Hung, Yong-Ye Yang, Tsung-Han Wang & Yin-Chou Hsu

  2. Department of Occupational Therapy, College of Medicine, I-Shou University, Kaohsiung, Taiwan

    Choon-Bing Chua

  3. School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung, 82445, Taiwan

    Yin-Chou Hsu

  4. School of Medicine for International Student, I-Shou University, Kaohsiung, 82445, Taiwan

    Yin-Chou Hsu

  5. Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan

    Yin-Chou Hsu

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  1. Choon-Bing Chua
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Contributions

Choon-Bing Chua and Yin-Chou Hsu designed the study. Chi-Chieh Hung, Yong-Ye Yang, and Tsung-Han Wang extracted the data and performed statistical analysis. Tsung-Han Wang and Yin-Chou Hsu prepared figures. Choon-Bing Chua, Chi-Chieh Hung, and Yong-Ye Yang prepared tables. Choon-Bing Chua, Chi-Chieh Hung, and Yin-Chou Hsu drafted the manuscript. All authors reviewed and approved the manuscript.

Corresponding author

Correspondence to Yin-Chou Hsu.

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Ethics approval

This observational study and process of anonymized data acquisition was approved by the Institutional Review Board of E-Da hospital (EMRP-109–044).

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The requirement for informed consent was waived owing to the retrospective observational nature of the study.

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Not applicable.

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The authors declare no competing interests.

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Chua, CB., Hung, CC., Yang, YY. et al. Comparison between culture-positive and culture-negative septic shock in patients in the emergency department. Eur J Clin Microbiol Infect Dis 41, 1285–1293 (2022). https://doi.org/10.1007/s10096-022-04496-3

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  • DOI: https://doi.org/10.1007/s10096-022-04496-3

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