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Original Research: Critical Care |

Culture-Negative Severe Sepsis: Nationwide Trends and Outcomes

Shipra Gupta, MD; Ankit Sakhuja, MD; Gagan Kumar, MD; Eric McGrath, MD; Rahul S. Nanchal, MD; Kianoush B. Kashani, MD, FCCP
Author and Funding Information

FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

aDivision of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI

bDivision of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI

cDepartment of Critical Care, Phoebe Putney Memorial Hospital, Albany, GA

dDepartment of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI

eDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN

CORRESPONDENCE TO: Ankit Sakhuja, MBBS, Division of Nephrology, Department of Internal Medicine, University of Michigan, 3914 Taubman Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(6):1251-1259. doi:10.1016/j.chest.2016.08.1460
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Background  Although 28% to 49% of severe sepsis hospitalizations have been described as being “culture negative,” there are very limited data on the epidemiology and outcomes of those with culture-negative severe sepsis (CNSS). The objectives of this study were to investigate the proportion and trends of CNSS and its association with mortality.

Methods  Using the Nationwide Inpatient Sample (NIS) database from 2000 to 2010, we identified adults hospitalized with severe sepsis. Those without any specific organism codes were identified as “with CNSS.” We examined the proportion of CNSS hospitalizations and rates of mortality associated with it. We also assessed the independent effect of CNSS on mortality.

Results  Of 6,843,279 admissions of patients with severe sepsis, 3,226,406 (47.1%) had culture-negative results. The age-adjusted proportion of CNSS increased from 33.9% in 2000 to 43.5% in 2010 (P < .001). Those with CNSS had more comorbidities, acute organ dysfunction (respiratory, cardiac, hepatic, and renal dysfunction), and in-hospital mortality (34.6% vs 22.7%; P < .001), although acute kidney injury requiring dialysis was less frequent (5.3% vs 6.1%; P < .001). CNSS was an independent predictor of mortality in those with severe sepsis (OR, 1.75; 95% CI, 1.72-1.77).

Conclusions  CNSS among hospitalized patients is common, and its proportion is on the rise. CNSS is associated with greater acute organ dysfunction and mortality. Having CNSS is an independent predictor of death.

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