Comparison of culture-negative and culture-positive sepsis or septic shock: a systematic review and meta-analysis.
Comparison of culture-negative and culture-positive sepsis or septic shock: a systematic review and meta-analysis.
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细菌培养阴性和阳性脓毒症或脓毒性休克的比较：一项系统综述和荟萃分析。
DOI：
10.1186/s13054-021-03592-8
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发表时间：
2021-05-08
期刊：
影响因子：
--
通讯作者：
Zhang D
中科院分区：
文献类型：
--
作者：
Li Y;Guo J;Yang H;Li H;Shen Y;Zhang D
细菌培养阴性和细菌培养阳性脓毒症患者的死亡率和其他临床结局的记录并不一致，并且非常有争议。进行了系统回顾和荟萃分析，以比较培养阴性和培养阳性脓毒症或脓毒性休克的临床结局。我们在PubMed、科克伦和Embase数据库中检索了从成立到2021年1月1日的研究。我们纳入了涉及脓毒症或脓毒性休克患者的研究。所有作者报告了我们的全因死亡率的主要结局，并明确比较了培养阴性与培养阳性患者的临床相关次要结局（ICU住院时间、住院时间、机械通气需求、机械通气持续时间和肾脏替代需求）。结果表示为比值比（OR）和平均差（MD）以及95%置信区间（CI）。纳入了7项研究，包括22，655例患者。该荟萃分析的主要结局显示，两组之间的全因死亡率无统计学显著差异（OR = 0.95; 95%CI，0.88 - 1.01; P = 0.12; Chi-2 = 30.71; I2 = 80%）。次要结果表明，ICU住院时间无统计学显著差异（MD = − 0.19;95% CI，− 0.42至0.04; P = 0.10;Chi-2 = 5.73; I2 = 48%），机械通气要求（OR = 1.02; 95%CI，0.94 ~ 1.11; P = 0.61;卡方2 = 6.32; I2 = 53%）和肾脏替代需求（OR = 0.82; 95%CI，0.67 ~ 1.01; P = 0.06;卡方2 = 1.21; I2 = 0%）。培养阳性组的住院时间长于培养阴性组（MD = − 3.48; 95%CI，− 4.34至− 2.63; P < 0.00001;Chi-2 = 1.03; I2 = 0%）。培养阳性组的机械通气持续时间长于培养阴性组（MD = − 0.64; 95%CI，− 0.88至− 0.4; P < 0.00001;Chi-2 = 4.86; I2 = 38%）。培养阳性或阴性与脓毒症或脓毒性休克患者的死亡率无关。此外，培养阳性脓毒症患者与培养阴性患者的ICU住院时间、机械通气要求和肾脏替代要求相似。细菌培养阳性脓毒症患者的住院时间和机械通气时间均长于细菌培养阴性脓毒症患者。还需要进一步的大规模研究来证实这些结果。
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. 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). 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%). 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.
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