Afzal Muhammad S, Nandan Chennuri Raj, Naveed Husnain, Raveena Bai Bansari, Hanif Rutaba, Shahzad Zoha, Umer Muhammed, Saleem Faraz
Department of Medicine, Carle Foundation Hospital, Urbana, USA.
Department of Medicine, Louisiana State University Shreveport, Shreveport, USA.
Cureus. 2023 Feb 24;15(2):e35416. doi: 10.7759/cureus.35416. eCollection 2023 Feb.
This meta-analysis has been conducted to compare the clinical outcomes between culture-positive and culture-negative sepsis or septic patients. The present meta-analysis is reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases, including PubMed and EMBASE, were searched by two authors independently from the inception to January 25, 2023, using the following key terms: "culture positive," "culture negative," "sepsis," and "septic shock." The primary outcome assessed in the present meta-analysis was all-cause mortality. Secondary outcomes included the need for mechanical ventilation, renal replacement therapy, length of ICU stay in days, and length of hospital stay in days. Total 10 studies met the inclusion criteria and were included in the meta-analysis involving 23,973 patients. No statistically significant difference was found between culture-positive and culture-negative patients in terms of all-cause mortality (risk ratio [RR]: 1.09, 95% CI: 0.95-1.24, p-value: 0.23), the need for mechanical ventilation (RR: 0.99, 95% CI: 0.93-1.05, p-value: 0.79), renal replacement therapy requirements (RR: 1.11, 95% CI: 0.95-1.31, p-value: 0.19), and ICU length of stay (mean difference [MD]: 1.70 days, 95% CI: -1.10, 4.49, p-value: 0.23). However, The mean hospital length of stay in days was significantly longer in patients in a culture-positive group compared to the culture-negative group (MD: 3.04, 95% CI: 2.25-3.82, p-value<0.001). In conclusion, the present meta-analysis of 10 studies, including 23,973 patients, found no significant differences in all-cause mortality, need for mechanical ventilation, need for renal replacement therapy, and length of ICU stay between culture-positive and culture-negative sepsis or septic patients. However, a significant difference was found in hospital length of stay, with culture-positive patients having a longer stay.
本荟萃分析旨在比较培养阳性与培养阴性脓毒症或脓毒症患者的临床结局。本荟萃分析按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行报告。两名作者独立检索了包括PubMed和EMBASE在内的电子数据库，检索时间从数据库建立至2023年1月25日，使用了以下关键词：“培养阳性”、“培养阴性”、“脓毒症”和“脓毒性休克”。本荟萃分析评估的主要结局是全因死亡率。次要结局包括机械通气需求、肾脏替代治疗需求、重症监护病房（ICU）住院天数和住院天数。共有10项研究符合纳入标准并被纳入涉及23973例患者的荟萃分析。在全因死亡率方面，培养阳性和培养阴性患者之间未发现统计学显著差异（风险比[RR]：1.09，95%置信区间[CI]：0.95 - 1.24，p值：0.23），在机械通气需求方面（RR：0.99，95%CI：0.93 - 1.05，p值：0.79），在肾脏替代治疗需求方面（RR：1.11，95%CI：0.95 - 1.31，p值：0.19），以及在ICU住院时间方面（平均差[MD]：1.70天，95%CI： - 1.10，4.49，p值：0.23）。然而，与培养阴性组相比，培养阳性组患者的平均住院天数显著更长（MD：3.04，95%CI：2.25 - 3.82，p值<0.001）。总之，本对10项研究（包括23973例患者）的荟萃分析发现，培养阳性与培养阴性脓毒症或脓毒症患者在全因死亡率、机械通气需求、肾脏替代治疗需求和ICU住院时间方面无显著差异。然而，在住院时间方面发现了显著差异，培养阳性患者住院时间更长。
