Prognostic Value of the Time-to-Positivity in Blood Cultures from Septic Shock Patients with Bacteremia Receiving Protocol-Driven Resuscitation Bundle Therapy: A Retrospective Cohort Study.

INTRODUCTION

To evaluate the prognostic value of the time-to-positivity in patients with culture-positive septic shock.

METHODS

Retrospective study using a prospective data registry was performed at the emergency department of a tertiary hospital. Consecutive adult patients with septic shock (N = 2499) were enrolled between 2014 and 2018. Bacteremia was defined using blood cultures, and viral and fungal pathogens were excluded. The primary outcome was the 28-day mortality.

RESULTS

In 803 (46.7%) septic shock patients with bacteremia, median TTP was 10.1 h. The most prevalent isolated bacterial pathogens were (40.8%) and (23.4%). Although the TTP correlated with a higher sequential organ failure assessment score (Spearman's rho = -0.12, < 0.01), it showed no significant difference between the 28-day survivors and non-survivors (10.2 vs. 9.4 days, = 0.35). In subgroup analysis of the and bacteremia cases, a shorter TTP showed prognostic value for predicting the 28-day mortality. The optimal TTP cut-off for and was 10 h and 8 h, respectively.

CONCLUSIONS

The prognostic value of the TTP in septic shock patients receiving bundle therapy may be limited and its clinical interpretation should only be made on a pathogen-specific basis.