The Departments of Critical Care Medicine, Geisinger Medical Center, Danville, PA.
Section of Infectious Diseases, Geisinger Medical Center, Danville, PA.
Crit Care Med. 2018 Apr;46(4):506-512. doi: 10.1097/CCM.0000000000002924.
To determine the clinical characteristics and outcomes of culture-negative septic shock in comparison with culture-positive septic shock.
Retrospective nested cohort study.
ICUs of 28 academic and community hospitals in three countries between 1997 and 2010.
Patients with culture-negative septic shock and culture-positive septic shock derived from a trinational (n = 8,670) database of patients with septic shock.
None.
Patients with culture-negative septic shock (n = 2,651; 30.6%) and culture-positive septic shock (n = 6,019; 69.4%) were identified. Culture-negative septic shock compared with culture-positive septic shock patients experienced similar ICU survival (58.3% vs 59.5%; p = 0.276) and overall hospital survival (47.3% vs 47.1%; p = 0.976). Severity of illness was similar between culture-negative septic shock and culture-positive septic shock groups ([mean and SD Acute Physiology and Chronic Health Evaluation II, 25.7 ± 8.3 vs 25.7 ± 8.1]; p = 0.723) as were serum lactate levels (3.0 [interquartile range, 1.7-6.1] vs 3.2 mmol/L [interquartile range, 1.8-5.9 mmol/L]; p = 0.366). As delays in the administration of appropriate antimicrobial therapy after the onset of hypotension increased, patients in both groups experienced congruent increases in overall hospital mortality: culture-negative septic shock (odds ratio, 1.56; 95% CI [1.47-1.66]; p < 0.0001) and culture-positive septic shock (odds ratio, 1.65; 95% CI [1.59-1.71]; p < 0.0001).
Patients with culture-negative septic shock behave similarly to those with culture-positive septic shock in nearly all respects; early appropriate antimicrobial therapy appears to improve mortality. Early recognition and eradication of infection is the most obvious effective strategy to improve hospital survival.
比较培养阴性脓毒症性休克与培养阳性脓毒症性休克的临床特征和结局。
回顾性巢式队列研究。
1997 年至 2010 年间，三个国家的 28 家学术和社区医院的 ICU。
来自脓毒症性休克三联数据库的培养阴性脓毒症性休克患者和培养阳性脓毒症性休克患者（n=8670）。
无。
确定了培养阴性脓毒症性休克患者（n=2651；30.6%）和培养阳性脓毒症性休克患者（n=6019；69.4%）。与培养阳性脓毒症性休克患者相比，培养阴性脓毒症性休克患者 ICU 生存率（58.3% vs 59.5%；p=0.276）和总住院生存率（47.3% vs 47.1%；p=0.976）相似。两组间疾病严重程度相似（[平均和标准差急性生理学和慢性健康评估 II，25.7±8.3 与 25.7±8.1]；p=0.723），血清乳酸水平也相似（3.0[四分位距，1.7-6.1]与 3.2mmol/L[四分位距，1.8-5.9mmol/L]；p=0.366）。随着低血压发作后开始适当抗菌治疗的延迟增加，两组患者的总住院死亡率均相应增加：培养阴性脓毒症性休克（优势比，1.56；95%置信区间[1.47-1.66]；p<0.0001）和培养阳性脓毒症性休克（优势比，1.65；95%置信区间[1.59-1.71]；p<0.0001）。
在几乎所有方面，培养阴性脓毒症性休克患者的表现与培养阳性脓毒症性休克患者相似；早期适当的抗菌治疗似乎可降低死亡率。早期识别和消除感染是提高住院生存率的最有效策略。
