Comparing outcomes between culture-positive and culture-negative septic shock in a PICU: A retrospective cohort study

Abstract

BackgroundWe assessed the outcomes and characteristics of culture-negative septic shock (CNSS) and culture-positive septic shock (CPSS) in pediatric intensive care unit (PICU).MethodsWe performed a retrospective study on the data of children admitted to the PICU due to septic shock between January 2018 and December 2021. The primary outcome was in-hospital mortality. The secondary outcomes were the length of stay (LOS) of hospital, the need for mechanical ventilation (MV) and continue renal replacement therapy (CRRT).ResultsOverall, 238 patients were enrolled. 114 patients (47.9%) had positive cultures (60 blood samples, 41 sputum samples, 17 pus samples, and 19 others), 18 of whom were cultured positive at two sites, 1 at three sites, and 3 had two different types of bacteria at same site. The in-hospital mortality was 47.1%. There were no significant differences in the in-hospital mortality (47.6% vs. 46.5%, P = 0.866), PRISM-III score (10 vs. 12, P = 0.409), PIM-3 score (0.08 vs. 0.07, P = 0.845), pSOFA score (10 vs. 10, P = 0.677) or the need for MV (64.5% vs. 68.4%, P = 0.524) and CRRT (29.8% vs. 34.2%, P = 0.470) between the CNSS group and the CPSS group. The Procalcitonin (8.89 ng/ml vs. 28.39 ng/ml, P = 0.001) and C-reactive protein (28 mg/L vs. 58 mg/L, P = 0.001) levels were significantly lower in the CNSS group than in the CPSS group, while WBC count (9.03 × 109/L vs. 5.02 × 109/L, P = 0.002) and serum sodium (137 mmol/L vs. 132 mmol/L, P = 0.001) was significantly higher in CNSS. The LOS of hospital was significantly longer (16 days vs. 11 days, P = 0.011) in the CPSS group than in the CNSS group, while the LOS of PICU (5 days vs. 4 days, P = 0.094) stay was not significantly different.ConclusionCompared with children with CNSS, children with CPSS had higher PCT and CRP levels, but lower WBC count. Children with CPSS had longer LOS of hospital. However, positive or negative culture results were not associated with in-hospital mortality, the LOS of PICU, the need for MV or CRRT in children with septic shock.

Comparison of Clinical Outcomes Between Culture-Positive and Culture-Negative Sepsis and Septic Shock Patients: A Meta-Analysis

“…Full texts of 18 studies were retrieved and assessed for eligibility criteria. Overall, 10 studies met the inclusion criteria [6][7][11][12][13][14][15][16][17][18] and were included in the meta-analysis involving 23,973 patients. The characteristics of the included studies are shown in Table 1.…”

“…The characteristics of the included studies are shown in Table 1. The majority of the included studies were retrospective cohorts [7,[11][12][13][14][16][17][18].…”

“…FIGURE 2: Forest plot comparing incidence of all-cause mortality.Sources: References[6][7][11][12][13][14][15][16][17][18] …”

“…FIGURE 6: Forest plot comparing length of hospital stay between the two groups.Sources: References[6,12,15,[17][18] …”

Comparison of the clinical characteristics and clinical outcomes of culture-positive septic shock and culture-negative septic shock among pediatric patients

“…While many studies compared the clinical features between CPSS and CNSS in adult patients, only few studies directly compared the two groups in the pediatric population [16][17][18]. In addition, the relationship between clinical characteristics and proven bacteria is not well-studied in pediatric patients with septic shock.…”