Meena Durga Shankar, Talkar Manish Anant, Kumar Deepak, Midha Naresh, Bohra Gopal Krishana, Tak Vibhor
Department of Internal Medicine, (Division of Infectious Diseases), All India Institute of Medical Sciences, Jodhpur, India.
Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, India.
Infez Med. 2025 Sep 1;33(3):294-302. doi: 10.53854/liim-3303-6. eCollection 2025.
Bacteremia is usually considered a marker for severe infection, yet the correlation between blood culture positivity and mortality in sepsis remains uncertain. This study aimed to evaluate whether blood culture positivity is associated with adverse clinical outcomes in patients with sepsis.
This prospective observational study included adult patients with sepsis admitted to a tertiary care hospital. Patients were classified into culture-positive and culture-negative groups based on blood culture results. Clinical outcomes including 30-day mortality, length of hospital stay, and vasopressor requirement were compared. Multivariable logistic and Cox regression models were used to assess the independent association of bacteremia with mortality, adjusting for age, and comorbidities.
Of 633 patients, 41.9% (n=265) were blood culture-positive. Although culture-positive patients had higher SOFA, SAPS II scores, and procalcitonin levels, 30-day mortality was similar between groups (20.8% vs. 26.1%; p=0.12). Length of hospital stay was comparable (median 14 vs. 16 days; p=0.374), as was ICU stay duration (p=0.693). On multivariable analysis, bacteremia was not independently associated with 30-day mortality (adjusted OR 0.62, 95% CI:0.28-1.37, p=0.236). Kaplan-Meier analysis showed a non-significant trend toward higher survival in the culture-positive group (HR 1.30, 95% CI: 0.80-2.10, p=0.293).
Although blood culture-positive sepsis was associated with higher disease severity at presentation, it did not result in increased 30-day mortality. These findings suggest that bacteremia alone does not determine sepsis outcomes, and culture-negative sepsis should be managed with equal clinical urgency.
菌血症通常被视为严重感染的一个指标，但脓毒症患者血培养阳性与死亡率之间的相关性仍不明确。本研究旨在评估脓毒症患者血培养阳性是否与不良临床结局相关。
这项前瞻性观察性研究纳入了一所三级护理医院收治的成年脓毒症患者。根据血培养结果将患者分为培养阳性组和培养阴性组。比较包括30天死亡率、住院时间和血管活性药物使用需求等临床结局。采用多变量逻辑回归和Cox回归模型评估菌血症与死亡率的独立关联，并对年龄和合并症进行校正。
633例患者中，41.9%（n = 265）血培养阳性。尽管培养阳性患者的序贯器官衰竭评估（SOFA）、简化急性生理学评分（SAPS）II分值及降钙素原水平更高，但两组间30天死亡率相似（20.8%对26.1%；p = 0.12）。住院时间相当（中位数14天对16天；p = 0.374），重症监护病房（ICU）住院时长也相当（p = 0.693）。多变量分析显示，菌血症与30天死亡率无独立关联（校正比值比[OR]0.62，95%置信区间[CI]：0.28 - 1.37，p = 0.236）。Kaplan - Meier分析显示，培养阳性组生存概率有升高趋势，但差异无统计学意义（风险比[HR]1.30，95%CI：0.80 - 2.10，p = 0.293）。
尽管血培养阳性的脓毒症在就诊时疾病严重程度更高，但并未导致30天死亡率增加。这些发现表明，仅菌血症并不能决定脓毒症的结局，对于血培养阴性的脓毒症应给予同样的临床紧急处理。
