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Original Research |

Culture Negative Severe Sepsis – Nationwide Trends and Outcomes

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

Summary Conflict of Interest Statement: None of the authors have reported any relevant conflicts of interest.

Funding Information: None

1Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Michigan, Detroit MI

2Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor MI

3Department of Critical Care, Phoebe Putney Memorial Hospital, Albany GA

4Department of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI

5Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester MN

Corresponding Author: Ankit Sakhuja MBBS FACP FASN, Division of Nephrology, Department of Internal Medicine, University of Michigan, 3914 Taubman Center, 1500 E Medical Center Drive, Ann Arbor, MI 48109.


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


Chest. 2016. doi:10.1016/j.chest.2016.08.1460
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Abstract

Background  Though 28-49% of severe sepsis hospitalizations have been described to be culture negative, there is very limited data on 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 Nationwide Inpatient Sample database from 2000-2010 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 with severe sepsis 3,226,406 (47.1% ) were culture negative. The age-adjusted proportion of CNSS has increased from 33.9% in 2000 to 43.5% in 2010 (p<0.001). Those with CNSS had more co-morbidities, acute organ dysfunctions (respiratory, cardiac, hepatic and renal) and in-hospital mortality (34.6% vs. 22.7%; p<0.001) though acute kidney injury requiring dialysis is less (5.3% vs. 6.1%; p<0.001). 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 dysfunctions and mortality. Being culture negative is an independent predictor of death.


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