An overview of positive cultures and clinical outcomes in septic patients: a sub-analysis of the Prehospital Antibiotics Against Sepsis (PHANTASi) trial

Abstract Background Sepsis remains one of the most important causes of morbidity and mortality worldwide. In approximately 30–50% of cases of suspected sepsis, no pathogen is isolated, disabling the clinician to treat the patient with targeted antimicrobial therapy. Studies investigating the differe...

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Main Authors: Rishi S. Nannan Panday, Eline M. J. Lammers, Nadia Alam, Prabath W. B. Nanayakkara
Format: Article
Language:English
Published: BMC 2019-05-01
Series:Critical Care
Subjects:
Online Access:http://link.springer.com/article/10.1186/s13054-019-2431-8
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spelling doaj-00dd0e9ab47540deb988d3558177c9052020-11-25T03:21:57ZengBMCCritical Care1364-85352019-05-012311910.1186/s13054-019-2431-8An overview of positive cultures and clinical outcomes in septic patients: a sub-analysis of the Prehospital Antibiotics Against Sepsis (PHANTASi) trialRishi S. Nannan Panday0Eline M. J. Lammers1Nadia Alam2Prabath W. B. Nanayakkara3Section Acute Medicine, Department of Internal Medicine Amsterdam UMC, University Medical Centers, Location VU University Medical Center, Vrije Universiteit AmsterdamSection Acute Medicine, Department of Internal Medicine Amsterdam UMC, University Medical Centers, Location VU University Medical Center, Vrije Universiteit AmsterdamSection Acute Medicine, Department of Internal Medicine Amsterdam UMC, University Medical Centers, Location VU University Medical Center, Vrije Universiteit AmsterdamSection Acute Medicine, Department of Internal Medicine Amsterdam UMC, University Medical Centers, Location VU University Medical Center, Vrije Universiteit AmsterdamAbstract Background Sepsis remains one of the most important causes of morbidity and mortality worldwide. In approximately 30–50% of cases of suspected sepsis, no pathogen is isolated, disabling the clinician to treat the patient with targeted antimicrobial therapy. Studies investigating the differences in the patient outcomes between culture-positive and culture-negative sepsis patients have only been conducted in subgroups of sepsis patients and results are ambiguous. Methods This is a sub-analysis of the PHANTASi (Prehospital Antibiotics Against Sepsis trial), a randomized controlled trial that focused on the effect of prehospital antibiotics in sepsis patients. We evaluated the outcome of cultures from different sources and determined what the clinical implications of having a positive culture compared to negative cultures were for patient outcomes. Furthermore, we looked at the effect of antibiotics on culture outcomes. Results 1133 patients (42.6%) with culture-positive sepsis were identified, compared to 1526 (56.4%) patients with culture-negative sepsis. 28-day mortality (RR 1.43 [95% CI 1.11–1.83]) and 90-day mortality (RR 1.41 [95% CI 1.15–1.71]) were significantly higher in culture-positive patients compared to culture-negative patients. Culture-positive sepsis was also associated with ≥ 3 organ systems affected during the sepsis episode (RR 4.27 [95% CI 2.78–6.60]). Patients who received antibiotics at home more often had negative blood cultures (85.9% vs. 78%) than those who did not (p < 0.001). Conclusions Our results show that culture-positive sepsis is associated with a higher mortality rate and culture-positive patients more often have multiple organ systems affected during the sepsis episode. Trial registration The PHANTASi trial is registered at ClinicalTrials.gov, number NCT01988428. Date of registration: November 20, 2013.http://link.springer.com/article/10.1186/s13054-019-2431-8Sepsis(Blood) cultureMortality(Multi) organ failureOrgan dysfunctionAntimicrobial therapy
collection DOAJ
language English
format Article
sources DOAJ
author Rishi S. Nannan Panday
Eline M. J. Lammers
Nadia Alam
Prabath W. B. Nanayakkara
spellingShingle Rishi S. Nannan Panday
Eline M. J. Lammers
Nadia Alam
Prabath W. B. Nanayakkara
An overview of positive cultures and clinical outcomes in septic patients: a sub-analysis of the Prehospital Antibiotics Against Sepsis (PHANTASi) trial
Critical Care
Sepsis
(Blood) culture
Mortality
(Multi) organ failure
Organ dysfunction
Antimicrobial therapy
author_facet Rishi S. Nannan Panday
Eline M. J. Lammers
Nadia Alam
Prabath W. B. Nanayakkara
author_sort Rishi S. Nannan Panday
title An overview of positive cultures and clinical outcomes in septic patients: a sub-analysis of the Prehospital Antibiotics Against Sepsis (PHANTASi) trial
title_short An overview of positive cultures and clinical outcomes in septic patients: a sub-analysis of the Prehospital Antibiotics Against Sepsis (PHANTASi) trial
title_full An overview of positive cultures and clinical outcomes in septic patients: a sub-analysis of the Prehospital Antibiotics Against Sepsis (PHANTASi) trial
title_fullStr An overview of positive cultures and clinical outcomes in septic patients: a sub-analysis of the Prehospital Antibiotics Against Sepsis (PHANTASi) trial
title_full_unstemmed An overview of positive cultures and clinical outcomes in septic patients: a sub-analysis of the Prehospital Antibiotics Against Sepsis (PHANTASi) trial
title_sort overview of positive cultures and clinical outcomes in septic patients: a sub-analysis of the prehospital antibiotics against sepsis (phantasi) trial
publisher BMC
series Critical Care
issn 1364-8535
publishDate 2019-05-01
description Abstract Background Sepsis remains one of the most important causes of morbidity and mortality worldwide. In approximately 30–50% of cases of suspected sepsis, no pathogen is isolated, disabling the clinician to treat the patient with targeted antimicrobial therapy. Studies investigating the differences in the patient outcomes between culture-positive and culture-negative sepsis patients have only been conducted in subgroups of sepsis patients and results are ambiguous. Methods This is a sub-analysis of the PHANTASi (Prehospital Antibiotics Against Sepsis trial), a randomized controlled trial that focused on the effect of prehospital antibiotics in sepsis patients. We evaluated the outcome of cultures from different sources and determined what the clinical implications of having a positive culture compared to negative cultures were for patient outcomes. Furthermore, we looked at the effect of antibiotics on culture outcomes. Results 1133 patients (42.6%) with culture-positive sepsis were identified, compared to 1526 (56.4%) patients with culture-negative sepsis. 28-day mortality (RR 1.43 [95% CI 1.11–1.83]) and 90-day mortality (RR 1.41 [95% CI 1.15–1.71]) were significantly higher in culture-positive patients compared to culture-negative patients. Culture-positive sepsis was also associated with ≥ 3 organ systems affected during the sepsis episode (RR 4.27 [95% CI 2.78–6.60]). Patients who received antibiotics at home more often had negative blood cultures (85.9% vs. 78%) than those who did not (p < 0.001). Conclusions Our results show that culture-positive sepsis is associated with a higher mortality rate and culture-positive patients more often have multiple organ systems affected during the sepsis episode. Trial registration The PHANTASi trial is registered at ClinicalTrials.gov, number NCT01988428. Date of registration: November 20, 2013.
topic Sepsis
(Blood) culture
Mortality
(Multi) organ failure
Organ dysfunction
Antimicrobial therapy
url http://link.springer.com/article/10.1186/s13054-019-2431-8
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