Association between Culture Positivity/Negativity and Outcome in Patients with Sepsis in a Critically Ill Patients

INTRODUCTION: Severe sepsis is a major cause of morbidity and mortality. Failure to administer antibiotics to which the pathogens are susceptible is associated with increased mortality. Thus, early broad-spectrum antibacterial agents are recommended as a means to improve survival. However, approximately 40% of patients with sepsis did not demonstrate identiable pathogens. Culture negativity status in patients with sepsis was presumed to have a lower disease severity due to the lesser extent of bacterial load.(1–3.) AIM AND OBJECTIVES: Aim of the study is to compare the clinical characteristics and adverse outcomes of ICU patients with culture-negative sepsis and culture-positive sepsis. OBJECTIVE OF THE STUDY: Primary objective: Is to assess the ICU & IN HOSPITAL mortality (30th days mortality) Secondary objective:: Days of ventilation. Need for dialysis. Length of icu stay. Length of hospital stay. MATERIALS AND METHODS: Study Area:- Critical Care unit at Jupiter hospital Study population:- Inclusion criteria:- All patients admitted to our CCU for sepsis and septic shock according to sepsis-3 guidelines, i.e sepsis with a lactate >2, & vasopressors support. Exclusion criteria:-: Non sepsis related shock eg:- (Cardiogenic, hypovolemic, or obstructive). Do not resuscitation status. Incomplete sepsis management strategy. Exclusion of Microbiologically proven fungal, viral & parasitic infection and tuberculosis. RESULTS: The age group 61–80 had the largest number of both positive (39, 53.4%) and negative (31, 59.6%) culture results. Males constituted 52% of the total subjects, with 45.2% having a positive culture. Females, on the other hand, comprised 48% of the study subjects, with 54.8% having a positive culture. 73 (58.4%) had a positive culture result, while 52 (41.6%) had a negative culture result. Pulmonary infection (35.2%) were most common source F/b Renal (25.6%) and abdominal source (18.4%). Out of 73 samples, 11 (15.03%) were Gram-positive, 50 (68.4%) were Gram-negative, and 12 (16.4%) had both positive and negative results. In gram positive organism, Enterococcus faecium had the highest mortality rate, with 5 out of 7 patients succumbing to the infection, resulting in a 71.4% mortality rate. In Gram-negative infections. E. Coli had the highest number of cases, with 26 positive patients, but a relatively low mortality rate of 19.2%, with 5 deaths reported. Klebsiella pneumoniae also showed significant incidence with 24 cases and a 29.2% mortality rate (7 deaths). Infections caused by Pseudomonas and Acinetobacter baumannii had more severe outcomes, with mortality rates of 33.3% and 66.7%, respectively. Blood cultures had the mortality, with 14 out of 38 patients dying (36.9% mortality rate). All other sites cultures positivity had a mortality rate, with 7 out of 35 patients dying (20% mortality rate). Of the 125 participants, 33 (26.4%) experienced mortality in the ICU, whereas 92 (73.6%) survived their ICU stay. CONCLUSION: The study's findings indicate that culture positivity in septic shock patients is associated with longer ICU and hospital stays and an increased need for critical interventions such as vasopressors and mechanical ventilation. However, despite these indications of increased illness severity, there was no statistically significant difference in overall mortality between culture-positive and culture-negative patients in this cohort. The identification of the causative organism allows for more targeted treatment, which can contribute to better clinical outcomes. While culture-positive septic shock patients exhibit more severe clinical presentations, the findings suggest that appropriate management can mitigate the impact of culture positivity on mortality.