Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil., Songpa-gu, Seoul, 05505, Korea.
Crit Care. 2021 Jan 6;25(1):11. doi: 10.1186/s13054-020-03421-4.
We evaluated the characteristics and outcomes of culture-negative versus culture-positive septic shock.
We performed a retrospective observational study of data from a prospective registry from 2014 to 2018. A total of 2,499 adult patients with septic shock were enrolled. The primary outcome was 90-day mortality, and the secondary outcomes were the length of hospital stay, a requirement for mechanical ventilation or renal replacement therapy, and in-hospital mortality.
Of 1,718 patients with septic shock, 1,012 (58.9%) patients were culture-positive (blood 803, urine 302, sputum 102, others 204) and the median pathogen detection time was 9.5 h (aerobic 10.2 h and anaerobic 9.0 h). The most common site of culture-positive infection was the hepatobiliary tract (39.5%), while for the culture-negative it was the lower respiratory tract (38.2%). The culture-negative group had a lower mean body temperature (37.3 vs 37.7 ℃), lactate (2.5 vs. 3.2 mmol/L), C-reactive protein (11.1 vs 11.9 mg/dL), and sequential organ failure assessment score (7.0 vs. 8.0) than that of the culture-positive group. However, 90-day mortality between the groups was not significantly different (32.7 vs 32.2%, p = 0.83), and the other clinical outcomes also did not differ significantly. Moreover, a shorter culture detection time was correlated with a higher sequential organ failure assessment score but not with mortality.
Patients with septic shock are frequently culture-negative, especially in cases where the infection focus is in the lower respiratory tract. Although culture-negative was associated with a degree of organ dysfunction, it was not an independent predictor of death.
我们评估了培养阴性与培养阳性感染性休克的特征和结局。
我们对 2014 年至 2018 年前瞻性登记研究的数据进行了回顾性观察研究。共纳入 2499 例成人感染性休克患者。主要结局为 90 天死亡率，次要结局为住院时间、机械通气或肾脏替代治疗的需求以及院内死亡率。
在 1718 例感染性休克患者中，1012 例（58.9%）为培养阳性（血 803 例，尿 302 例，痰 102 例，其他部位 204 例），中位病原体检测时间为 9.5 小时（需氧菌 10.2 小时，厌氧菌 9.0 小时）。培养阳性感染最常见的部位是肝胆系统（39.5%），而培养阴性感染最常见的部位是下呼吸道（38.2%）。培养阴性组的平均体温（37.3℃比 37.7℃）、乳酸（2.5mmol/L 比 3.2mmol/L）、C 反应蛋白（11.1mg/dL 比 11.9mg/dL）和序贯器官衰竭评估评分（7.0 分比 8.0 分）均低于培养阳性组。然而，两组 90 天死亡率无显著差异（32.7%比 32.2%，p=0.83），其他临床结局也无显著差异。此外，较短的培养检测时间与较高的序贯器官衰竭评估评分相关，但与死亡率无关。
感染性休克患者常为培养阴性，尤其是感染部位在下呼吸道时。尽管培养阴性与一定程度的器官功能障碍相关，但它不是死亡的独立预测因素。
