Prognostic Value of the Time-to-Positivity in Blood Cultures from Septic Shock Patients with Bacteremia Receiving Protocol-Driven Resuscitation Bundle Therapy: A Retrospective Cohort Study
Introduction: To evaluate the prognostic value of the time-to-positivity in patients with culture-positive septic shock. Methods: Retrospective study using a prospective data registry was performed at the emergency department of a tertiary hospital. Consecutive adult patients with septic shock (N =...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2021-06-01
|
| Series: | Antibiotics |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2079-6382/10/6/683 |
| _version_ | 1797530979691134976 |
|---|---|
| author | Hong-Jun Bae June-sung Kim Muyeol Kim Youn-Jung Kim Won Young Kim |
| author_facet | Hong-Jun Bae June-sung Kim Muyeol Kim Youn-Jung Kim Won Young Kim |
| author_sort | Hong-Jun Bae |
| collection | DOAJ |
| description | Introduction: To evaluate the prognostic value of the time-to-positivity in patients with culture-positive septic shock. Methods: Retrospective study using a prospective data registry was performed at the emergency department of a tertiary hospital. Consecutive adult patients with septic shock (N = 2499) were enrolled between 2014 and 2018. Bacteremia was defined using blood cultures, and viral and fungal pathogens were excluded. The primary outcome was the 28-day mortality. Results: In 803 (46.7%) septic shock patients with bacteremia, median TTP was 10.1 h. The most prevalent isolated bacterial pathogens were <i>Escherichia coli</i> (40.8%) and <i>Klebsiella</i> (23.4%). Although the TTP correlated with a higher sequential organ failure assessment score (Spearman’s rho = −0.12, <i>p</i> < 0.01), it showed no significant difference between the 28-day survivors and non-survivors (10.2 vs. 9.4 days, <i>p</i> = 0.35). In subgroup analysis of the <i>Escherichia coli</i> and <i>Klebsiella</i> bacteremia cases, a shorter TTP showed prognostic value for predicting the 28-day mortality. The optimal TTP cut-off for <i>Escherichia coli</i> and <i>Klebsiella</i> was 10 h and 8 h, respectively. Conclusions: The prognostic value of the TTP in septic shock patients receiving bundle therapy may be limited and its clinical interpretation should only be made on a pathogen-specific basis. |
| first_indexed | 2024-03-10T10:37:36Z |
| format | Article |
| id | doaj.art-ecb5dfc6a5b14a94994c0f6af3261440 |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-10T10:37:36Z |
| publishDate | 2021-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-ecb5dfc6a5b14a94994c0f6af32614402023-11-21T23:14:35ZengMDPI AGAntibiotics2079-63822021-06-0110668310.3390/antibiotics10060683Prognostic Value of the Time-to-Positivity in Blood Cultures from Septic Shock Patients with Bacteremia Receiving Protocol-Driven Resuscitation Bundle Therapy: A Retrospective Cohort StudyHong-Jun Bae0June-sung Kim1Muyeol Kim2Youn-Jung Kim3Won Young Kim4Asan Medical Center, Department of Emergency Medicine, College of Medicine, University of Ulsan, Seoul 05505, KoreaAsan Medical Center, Department of Emergency Medicine, College of Medicine, University of Ulsan, Seoul 05505, KoreaAsan Medical Center, Department of Emergency Medicine, College of Medicine, University of Ulsan, Seoul 05505, KoreaAsan Medical Center, Department of Emergency Medicine, College of Medicine, University of Ulsan, Seoul 05505, KoreaAsan Medical Center, Department of Emergency Medicine, College of Medicine, University of Ulsan, Seoul 05505, KoreaIntroduction: To evaluate the prognostic value of the time-to-positivity in patients with culture-positive septic shock. Methods: Retrospective study using a prospective data registry was performed at the emergency department of a tertiary hospital. Consecutive adult patients with septic shock (N = 2499) were enrolled between 2014 and 2018. Bacteremia was defined using blood cultures, and viral and fungal pathogens were excluded. The primary outcome was the 28-day mortality. Results: In 803 (46.7%) septic shock patients with bacteremia, median TTP was 10.1 h. The most prevalent isolated bacterial pathogens were <i>Escherichia coli</i> (40.8%) and <i>Klebsiella</i> (23.4%). Although the TTP correlated with a higher sequential organ failure assessment score (Spearman’s rho = −0.12, <i>p</i> < 0.01), it showed no significant difference between the 28-day survivors and non-survivors (10.2 vs. 9.4 days, <i>p</i> = 0.35). In subgroup analysis of the <i>Escherichia coli</i> and <i>Klebsiella</i> bacteremia cases, a shorter TTP showed prognostic value for predicting the 28-day mortality. The optimal TTP cut-off for <i>Escherichia coli</i> and <i>Klebsiella</i> was 10 h and 8 h, respectively. Conclusions: The prognostic value of the TTP in septic shock patients receiving bundle therapy may be limited and its clinical interpretation should only be made on a pathogen-specific basis.https://www.mdpi.com/2079-6382/10/6/683sepsisseptic shocktime-to-positivitybacteremiamortality |
| spellingShingle | Hong-Jun Bae June-sung Kim Muyeol Kim Youn-Jung Kim Won Young Kim Prognostic Value of the Time-to-Positivity in Blood Cultures from Septic Shock Patients with Bacteremia Receiving Protocol-Driven Resuscitation Bundle Therapy: A Retrospective Cohort Study Antibiotics sepsis septic shock time-to-positivity bacteremia mortality |
| title | Prognostic Value of the Time-to-Positivity in Blood Cultures from Septic Shock Patients with Bacteremia Receiving Protocol-Driven Resuscitation Bundle Therapy: A Retrospective Cohort Study |
| title_full | Prognostic Value of the Time-to-Positivity in Blood Cultures from Septic Shock Patients with Bacteremia Receiving Protocol-Driven Resuscitation Bundle Therapy: A Retrospective Cohort Study |
| title_fullStr | Prognostic Value of the Time-to-Positivity in Blood Cultures from Septic Shock Patients with Bacteremia Receiving Protocol-Driven Resuscitation Bundle Therapy: A Retrospective Cohort Study |
| title_full_unstemmed | Prognostic Value of the Time-to-Positivity in Blood Cultures from Septic Shock Patients with Bacteremia Receiving Protocol-Driven Resuscitation Bundle Therapy: A Retrospective Cohort Study |
| title_short | Prognostic Value of the Time-to-Positivity in Blood Cultures from Septic Shock Patients with Bacteremia Receiving Protocol-Driven Resuscitation Bundle Therapy: A Retrospective Cohort Study |
| title_sort | prognostic value of the time to positivity in blood cultures from septic shock patients with bacteremia receiving protocol driven resuscitation bundle therapy a retrospective cohort study |
| topic | sepsis septic shock time-to-positivity bacteremia mortality |
| url | https://www.mdpi.com/2079-6382/10/6/683 |
| work_keys_str_mv | AT hongjunbae prognosticvalueofthetimetopositivityinbloodculturesfromsepticshockpatientswithbacteremiareceivingprotocoldrivenresuscitationbundletherapyaretrospectivecohortstudy AT junesungkim prognosticvalueofthetimetopositivityinbloodculturesfromsepticshockpatientswithbacteremiareceivingprotocoldrivenresuscitationbundletherapyaretrospectivecohortstudy AT muyeolkim prognosticvalueofthetimetopositivityinbloodculturesfromsepticshockpatientswithbacteremiareceivingprotocoldrivenresuscitationbundletherapyaretrospectivecohortstudy AT younjungkim prognosticvalueofthetimetopositivityinbloodculturesfromsepticshockpatientswithbacteremiareceivingprotocoldrivenresuscitationbundletherapyaretrospectivecohortstudy AT wonyoungkim prognosticvalueofthetimetopositivityinbloodculturesfromsepticshockpatientswithbacteremiareceivingprotocoldrivenresuscitationbundletherapyaretrospectivecohortstudy |