Comparison of culture-negative and culture-positive sepsis or septic shock: a systematic review and meta-analysis

Abstract

Background Mortality and other clinical outcomes between culture-negative and culture-positive septic patients have been documented inconsistently and are very controversial. A systematic review and meta-analysis was performed to compare the clinical outcomes of culture-negative and culture-positive sepsis or septic shock. Methods We searched the PubMed, Cochrane and Embase databases for studies from inception to the 1st of January 2021. We included studies involving patients with sepsis or septic shock. All authors reported our primary outcome of all-cause mortality and clearly compared culture-negative versus culture-positive patients with clinically relevant secondary outcomes (ICU length of stay, hospital length of stay, mechanical ventilation requirements, mechanical ventilation duration and renal replacement requirements). Results were expressed as odds ratio (OR) and mean difference (MD) with accompanying 95% confidence interval (CI). Results Seven studies including 22,655 patients were included. The primary outcome of this meta-analysis showed that there was no statistically significant difference in the all-cause mortality between two groups (OR = 0.95; 95% CI, 0.88 to 1.01; P = 0.12; Chi-2 = 30.71; I2 = 80%). Secondary outcomes demonstrated that there was no statistically significant difference in the ICU length of stay (MD = − 0.19;95% CI, − 0.42 to 0.04; P = 0.10;Chi-2 = 5.73; I2 = 48%), mechanical ventilation requirements (OR = 1.02; 95% CI, 0.94 to 1.11; P = 0.61; Chi2 = 6.32; I2 = 53%) and renal replacement requirements (OR = 0.82; 95% CI, 0.67 to 1.01; P = 0.06; Chi-2 = 1.21; I2 = 0%) between two groups. The hospital length of stay of culture-positive group was longer than that of the culture-negative group (MD = − 3.48;95% CI, − 4.34 to − 2.63; P < 0.00001;Chi-2 = 1.03; I2 = 0%). The mechanical ventilation duration of culture-positive group was longer than that of the culture-negative group (MD = − 0.64;95% CI, − 0.88 to − 0.4; P < 0.00001;Chi-2 = 4.86; I2 = 38%). Conclusions Culture positivity or negativity was not associated with mortality of sepsis or septic shock patients. Furthermore, culture-positive septic patients had similar ICU length of stay, mechanical ventilation requirements and renal replacement requirements as those culture-negative patients. The hospital length of stay and mechanical ventilation duration of culture-positive septic patients were both longer than that of the culture-negative patients. Further large-scale studies are still required to confirm these results.

Comparison of culture‑negative and culture‑positive sepsis or septic shock: outcomes are more influenced by the nature of the infectious agent itself than by the samples’ positivity

“…Nevertheless, beyond all these limitations, we fully agree with Li et al [ 1 ] that larger-scale studies are required to confirm or infirm their results.…”

“…Recently in the Journal, Li et al [ 1 ] reported that culture positivity or negativity was not associated with differences in mortality, intensive care unit length of stay (LOS), mechanical ventilation requirements and renal replacement requirements of sepsis or septic shock patients. Conversely, hospital length of stay and mechanical ventilation duration of culture-positive septic patients were longer than those of culture-negative patients.…”

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

“…The differences between these two groups are likely due to differences in patient populations, proportions of infection sites and resistance to antibiotics. 18 The long periods under mechanical ventilation, including under invasive ventilators and non-invasive ventilators, as well as the length of stay in the ICU, and the higher in-hospital mortality rate that was observed in the culture-positive patients were likely attributed to the greater occurrence of risk factors. These risk factors included patients being older, and having more severe infections, worse For personal use only.…”

“…In addition, the clinical outcomes could be associated with the infection sources as well as the management of the sepsis patients. 18 Early comprehensive treatments, such as fluid resuscitation, appropriate use of antibiotics, nutritional support, and cleaning and care of infected sites, played a vital role in reducing mortality and improving clinical prognosis. Differently to culture-positive patients, the clinical prognosis of culture-negative patients was also not good despite their late mortality being lower.…”

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

“…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 ].…”