Culture-Negative Septic Shock Compared With Culture-Positive Septic Shock: A Retrospective Cohort Study
Culture-Negative Septic Shock Compared With Culture-Positive Septic Shock: A Retrospective Cohort Study
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DOI：
10.1097/ccm.0000000000002924
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发表时间：
2018-04-01
影响因子：
8.8
通讯作者：
Kumar, Anand
中科院分区：
文献类型：
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作者：
Kethireddy, Shravan;Bilgili, Beliz;Kumar, Anand
目的：目的：比较细菌培养阴性和细菌培养阳性感染性休克的临床特征和预后。设计：回顾性巢式队列研究。背景：1997年至2010年间，三个国家28家学术和社区医院的ICU。受试者：来自三个国家的感染性休克培养阴性和培养阳性患者测量和主要结果：确定了培养阴性的感染性休克患者（n = 2，651; 30.6%）和培养阳性的感染性休克患者（n = 6，019; 69.4%）。与培养阳性脓毒性休克患者相比，培养阴性脓毒性休克患者的ICU生存率（58.3% vs 59.5%; p = 0.276）和总住院生存率（47.3% vs 47.1%; p = 0.976）相似。细菌培养阴性的感染性休克组和细菌培养阳性的感染性休克组的疾病严重程度相似（[平均值和SD急性生理学和慢性健康评估II，25.7 +/- 8.3 vs 25.7 +/- 8.1]; p = 0.723）以及血清乳酸水平（3.0 [四分位距，1.7-6.1] vs 3.2 mmol/L [四分位距，1.8-5.9 mmol/L]; p = 0.366）。随着低血压发生后适当的抗菌治疗延迟的增加，两组患者的总体住院死亡率一致增加：培养阴性的感染性休克（比值比，1.56; 95% CI [1.47-1.66]; p < 0.0001）和培养阳性脓毒性休克（优势比，1.65; 95% CI [1.59-1.71]; p < 0.0001）。结论：脓毒性休克培养阴性患者与脓毒性休克培养阳性患者在几乎所有方面表现相似;早期适当的抗菌治疗似乎可以改善死亡率。早期识别和根除感染是提高住院生存率的最明显有效策略。
Objectives: To determine the clinical characteristics and outcomes of culture-negative septic shock in comparison with culture-positive septic shock.Design: Retrospective nested cohort study.Setting: ICUs of 28 academic and community hospitals in three countries between 1997 and 2010.Subjects: Patients with culture-negative septic shock and culture-positive septic shock derived from a trinational (n = 8,670) database of patients with septic shock.Interventions: None.Measurements and Main Results: Patients with culture-negative septic shock (n = 2,651; 30.6%) and culture-positive septic shock (n = 6,019; 69.4%) were identified. Culture-negative septic shock compared with culture-positive septic shock patients experienced similar ICU survival (58.3% vs 59.5%; p = 0.276) and overall hospital survival (47.3% vs 47.1%; p = 0.976). Severity of illness was similar between culture-negative septic shock and culture-positive septic shock groups ([mean and SD Acute Physiology and Chronic Health Evaluation II, 25.7 +/- 8.3 vs 25.7 +/- 8.1]; p = 0.723) as were serum lactate levels (3.0 [interquartile range, 1.7-6.1] vs 3.2 mmol/L [interquartile range, 1.8-5.9 mmol/L]; p = 0.366). As delays in the administration of appropriate antimicrobial therapy after the onset of hypotension increased, patients in both groups experienced congruent increases in overall hospital mortality: culture-negative septic shock (odds ratio, 1.56; 95% CI [1.47-1.66]; p < 0.0001) and culture-positive septic shock (odds ratio, 1.65; 95% CI [1.59-1.71]; p < 0.0001).Conclusions: Patients with culture-negative septic shock behave similarly to those with culture-positive septic shock in nearly all respects; early appropriate antimicrobial therapy appears to improve mortality. Early recognition and eradication of infection is the most obvious effective strategy to improve hospital survival.