Comparing mortality between positive and negative blood culture results: an inverse probability of treatment weighting analysis of a multicenter cohort

Liu, Aibo; Yo, Chia‐Hung; Nie, Lu; Yu, Hua; Wu, Kuihai; Tong, Hoi Sin; Hsu, Tien-Pen; Hsu, Wan‐Ting; Lee, Chien‐Chang

doi:10.1186/s12879-021-05862-w

Cited by 8 publications

(11 citation statements)

References 25 publications

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“…The major infection sites were grouped as the lower respiratory tract, urinary tract and abdominal infection, and the minor sites were grouped as isolated blood stream infection, skin and soft tissue infection, and the central nervous system. 17 The collected data include demographics, underlying diseases, initial vital signs, infection sites, and clinical outcomes, such as ICU admission, duration of ICU stay and expenditure, and mechanical ventilation requirements. The date of the patient's death was obtained from the hospital's electronic medical record system.…”

Section: Data Collection and Definition Of Variablesmentioning

confidence: 99%

Comparison of Clinical Characteristics and Outcomes Between Positive and Negative Blood Culture Septic Patients: A Retrospective Cohort Study

Yang¹,

Lin²,

Wang³

et al. 2021

IDR

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Background: Few studies have studied the relationship between blood culture and mortality in sepsis patients. The aim of this study was to compare the characteristics and outcomes of positive and negative blood culture sepsis. Methods: We performed a study on 640 patients suffering from sepsis in Beijing Chao-Yang Hospital from October 2017 to December 2019. The primary findings revolved around length and expenditure of hospital stay, the possibility of suffering from acute respiratory distress syndrome (ARDS), and any requirements for mechanical ventilation. The secondary findings revolved around whether the patient died early (28-day) or late (28-to-90-day). Results: A total of 592 of the 640 patients met the inclusion criteria for sepsis, with 274 of them having culture-positive results. The culture-positive patients were mostly elderly suffering from diabetes and at risk of cancer, with a higher white blood cell count, and higher procalcitonin. Additionally, they scored higher in their acute physiology and chronic health evaluation II score (15 vs.11, P=0.010), as well as in their predisposition, infection, response, and organ dysfunction (17 vs 11, P<0.001) than the individuals in the culturenegative group. Culture-positive patients had a longer duration of hospital stay (14 vs 6, P<0.001) and higher in-hospital mortality (14.6% vs 8.5%, P=0.019) than culture-negative ones. No significant difference in intensive care unit (ICU) mortality (45.7% vs.36.4%, P=0.254) or early mortality (9.5% vs 7.2%, P=0.321) was noted between the two groups. However, the culture-positive patients had increased late mortality (15.7% vs.6.9%, P=0.001), when compared with those with culture-negative results in the cohort. Furthermore, the culture-positive patients who received the appropriate antibiotics early had a lower mortality rate than the culture-negative patients (7.3% vs.14.2%, P=0.008). Conclusion: Culture-positive patients had higher in-hospital mortality, comparable early mortality, and worse late mortality than the culture-negative patients. Early appropriate use of antibiotics might reduce mortality and improve clinical prognosis.

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Section: Data Collection and Definition Of Variablesmentioning

confidence: 99%

Comparison of Clinical Characteristics and Outcomes Between Positive and Negative Blood Culture Septic Patients: A Retrospective Cohort Study

Yang¹,

Lin²,

Wang³

et al. 2021

IDR

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“…In conclusion, several clinical and laboratory variables showed promising predictive possibilities for mortality, with sepsis among them. To our knowledge, our study is the first observational study demonstrating increased mortality risk in calves with sepsis, a contested topic in human medicine 55‐61 …”

Section: Discussionmentioning

confidence: 89%

“…To our knowledge, our study is the first observational study demonstrating increased mortality risk in calves with sepsis, a contested topic in human medicine. [55][56][57][58][59][60][61] Information on bacteria involved in sepsis and their antimicrobial resistance profile is limited, especially in Europe. Therefore, our second objective was to obtain knowledge on the bacteria involved in sepsis in critically ill calves and their antimicrobial susceptibility.…”

Section: Bacteria and Antimicrobial Resistancementioning

confidence: 99%

Sepsis and survival in critically ill calves: Risk factors and antimicrobial use

Pas

Bokma

Lowie

et al. 2022

Veterinary Internal Medicne

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Background Sepsis is a life‐threatening disease for which critically important antimicrobials (CIA) frequently are used. Diagnostic and therapeutic guidelines for sepsis and critically ill calves are largely lacking. Objectives Identify factors associated with mortality in critically ill calves and describe bacteria obtained from blood cultures of critically ill calves with sepsis and their antimicrobial resistance. Animals Two‐hundred thirty critically ill calves, mainly Belgian Blue beef cattle. Methods Retrospective cohort study. Logistic regression, survival analysis, and decision tree analysis were used to determine factors associated with mortality. Results Of the critically ill calves, 34.3% had sepsis and 61.3% died. The final survival model indicated that calves with sepsis (hazard risk [HR]: 1.6; 95% confidence interval [CI]: 1.0‐2.5; P = .05), abnormal behavior (HR: 2.3; 95% CI: 1.3‐4.0; P = .005), and hypothermia (HR: 0.82; 95% CI: 0.72‐0.95; P = .01) had a significantly higher mortality risk. In a second survival model, hypothermia (HR: 0.87; 95% CI: 0.78‐0.96; P = .004) and hypoglycemia (HR: 2.2; 95% CI: 1.5‐3.3; P < .001) were risk factors for mortality. Decision tree analysis emphasized the importance of behavior, hypochloremia, hypoglycemia, hyperkalemia, and lung ultrasonography for mortality risk. Escherichia coli (30.6%) was most frequently isolated from blood cultures, of which 90.9% were multidrug resistant. Inappropriate use of antimicrobials was frequent for penicillin, amoxicillin, and sulfamethoxazole/trimethoprim, but less for CIA. Conclusions and Clinical Importance Many critically ill calves have sepsis, which increases mortality risk. Bacteria involved are often resistant to first‐intention antimicrobials but less resistant to CIA. The other identified risk factors for mortality can support therapeutic decision‐making.

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“…Recently, Liu et al . using the inverse probability of treatment weighting method to investigate the impact of positive blood culture on 30 and 90-day mortality among 1405 patients with suspected sepsis, found that blood culture-positive patients had similar 30-day mortality but higher 90-day mortality than those in culture-negative patients [ 16 ]. The aforementioned data showed that culture positivity appears to be associated with long-term outcomes instead of short-term outcomes; therefore, there is an essential need for studies focusing on long-term outcomes in critically ill patients.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have explored the association between culture positivity, a positive microbial culture of clinical samples during admission, and mortality in critically ill patients, but the evidence appeared to be inconclusive due to high heterogeneity among studies, with the majority of studies explored the short-term impact of culture positivity among patients with sepsis in the medical ICU [ 12 – 14 ]. Few studies, including our previous study focusing on 638 patients with cancer receiving perioperative intensive care, have found that culture positivity tended to be associated with 1-year mortality instead of short-term mortality [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

The association between culture positivity and long-term mortality in critically ill surgical patients

Wong

et al. 2021

j intensive care

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Background The long-term outcome is an essential issue in critically ill patients, and the identification of early determinant is needed for risk stratification of the long-term outcome. In the present study, we investigate the association between culture positivity during admission and long-term outcome in critically ill surgical patients. Methods We linked the 2015–2019 critical care database at Taichung Veterans General Hospital with the nationwide death registration files in Taiwan. We described the long-term mortality and proportion of culture positivity among enrolled subjects. We used a log-rank test to estimate survival curves between patients with and without positive cultures and a multivariable Cox proportional hazards regression model to determine hazard ratio (HR) and 95% confidence interval (CI). Results A total of 6748 critically ill patients were enrolled, and 32.5% (2196/6749) of them died during the follow-up period, with the overall follow-up duration was 1.8 ± 1.4 years. We found that 31.4% (2122/6748) of critically ill patients had at least one positive culture during the index admission, and the number of patients with positive culture in the blood, respiratory tract, urinary tract, skin and soft tissue and abdomen were 417, 1702, 554, 194 and 139, respectively. We found that a positive culture from any sites was independently associated with high long-term mortality (aHR 1.579, 95% CI 1.422–1.754) after adjusting relevant covariates, including age, sex, body-mass index, comorbidities, severity score, shock, early fluid overload, receiving mechanical ventilation and the need of renal replacement therapy for critical illness. Conclusions We linked two databases to identify that a positive culture during admission was independently correlated with increased long-term mortality in critically ill surgical patients. Our findings highlight the need for vigilance among patients with a positive culture during admission, and more studies are warranted to validate our findings and to clarify underlying mechanisms.

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Comparing mortality between positive and negative blood culture results: an inverse probability of treatment weighting analysis of a multicenter cohort

Cited by 8 publications

References 25 publications

Comparison of Clinical Characteristics and Outcomes Between Positive and Negative Blood Culture Septic Patients: A Retrospective Cohort Study

Comparison of Clinical Characteristics and Outcomes Between Positive and Negative Blood Culture Septic Patients: A Retrospective Cohort Study

Sepsis and survival in critically ill calves: Risk factors and antimicrobial use

The association between culture positivity and long-term mortality in critically ill surgical patients

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