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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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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