Comparison between culture-positive and culture-negative septic shock in patients in the emergency department.

Culture results of patients with septic shock affect their management strategies, including antibiotic administration. This study aimed to compare clinical characteristics and outcomes of patients with culture-negative septic shock (CNSS) and culture-positive septic shock (CPSS) in the emergency department. We also assessed the differences in duration and de-escalation timing of antibiotic administration between the two groups. This single-center, retrospective, case-control study included adult patients diagnosed with septic shock in the emergency department between January 1, 2019 and March 31, 2020. They were divided into the CNSS and CPSS groups based on their culture results. The baseline characteristics, infection sites, culture types, and clinical outcomes were recorded and compared. Patients with CPSS (63.7%, 311/488) and CNSS (36.3%, 177/488) were identified. The CPSS and CNSS groups had comparable clinical outcomes, including mechanical ventilation (29.6% vs. 32.8%, p = 0.46), renal replacement therapy (19.3% vs. 23.2%, p = 0.31), 30-day mortality (35.7% vs. 36.7%, p = 0.82), and in-hospital mortality (39.5% vs. 41.8%, p = 0.63). The CNSS group had a significantly shorter duration (13 [8 - 19] vs. 16 [10 - 23], days, p = 0.04) and earlier de-escalation timing (5 [2 - 9] vs. 9 [7 - 12], day, p = 0.02) of antibiotic administration than the CPSS group. Patients with CNSS and CPSS had similar clinical characteristics and proportion of adverse outcomes. Physicians can evaluate the feasibility of early de-escalation or discontinuation of antibiotic administration in patients with CNSS showing clinical improvement.

Prognostic Values of the Timing of Antibiotic Administration and the Sepsis Bundle Component in Elderly Patients With Septic Shock: A Retrospective Study.

INTRODUCTION: Elderly patients are more susceptible to sepsis and septic shock. Early administration of broad-spectrum antibiotics is a key element of the sepsis management of bundle. Our study aimed to investigate the association between the timing of antibiotics administration and the risk of adverse outcomes in elderly patients with septic shock, and to examine the prognostic value of other bundle elements. METHOD: This is a single-center, retrospective, case-control study including elderly patients (aged ≥ 65 years) diagnosed with septic shock in the emergency department between October 1, 2018, and December 31, 2019. Eligible patients were divided into early (within 1 h) and late (beyond 1 h) groups according to the time interval between septic shock recognition and initial antibiotic administration. The characteristics, sepsis-related severity scores, management strategy, and outcomes were recorded. A multivariate logistic regression model was used to identify the independent prognostic factors. RESULTS: A total of 331 patients were included in the study. The overall 90-day mortality rate was 43.8% (145/331). There were no significant differences in baseline characteristics, sepsis-related severity scores, and management strategy between the two groups. There was no significant difference between the early and late groups in the rate of intensive care unit transfer (46.4% vs. 46.6%, P = 0.96), endotracheal intubation (28.3% vs. 27.5%, P = 0.87), renal replacement therapy (21.7% vs. 21.8%, P = 1.00), or 90-day mortality (44.2% vs. 43.5%, P = 0.90). Serum lactate level (hazard ratio [HR] = 1.15, P < 0.01) and source control (HR = 0.56, P = 0.03) were identified as independent factors associated with 90-day mortality. CONCLUSION: The timing of antibiotic administration was not associated with adverse outcomes in elderly patients with septic shock. Serum lactate level and source control implementation were independent prognostic factors in these patients.

Comparing Mortality Risk Predictive Ability of Different Scoring Systems in Cirrhotic Patients with Bacteremia.

Patients with liver cirrhosis and bacteremia have substantially higher risk of mortality and morbidity. Our study aimed to investigate scoring systems that can predict the mortality risk in patients with cirrhosis and bacteremia. A single-center, retrospective cohort study was performed among adult patients who visited the emergency department from January 2015 to December 2018. All patients diagnosed with liver cirrhosis and bacteremia were enrolled and divided into survivor and nonsurvivor groups for comparison based on their 30-day in-hospital mortality event. The Pitt bacteremia score (PBS), model for end-stage liver disease (MELD) score, Child-Pugh score, and quick sequential Organ Failure Assessment (qSOFA) score were calculated and compared using the area under the receiver operating characteristic (AUROC) curves. A total of 127 patients (survivor: 86; nonsurvivor: 41) were eligible for this study. Compared with the nonsurvivor group, patients in the survivor group had significantly lower MELD score (22 ± 7 vs. 29 ± 5, p < 0.001), lower proportion of high qSOFA (score ≥ 2) (23.3% vs. 51.2%, p < 0.01), and high PBS (score ≥ 4) (7.0% vs. 34.1%, p < 0.001) category. There was also a significantly different distribution in Child-Pugh classification between the two groups (p < 0.01). The survivor group had significantly lower proportion of acute-on-chronic liver failure (27.9% vs. 68.3%, p < 0.001) and fewer number of organ failures (p < 0.001). In comparison of the discriminative ability in mortality risk prediction, PBS (AUROC = 0.83, 95% CI = 0.75-0.90, p < 0.001) and MELD scores (AUROC = 0.78, 95% CI = 0.70-0.86, p < 0.001) revealed a better predictive ability than Child-Pugh (AUROC = 0.69, 95% CI = 0.59-0.70, p < 0.01) and qSOFA scores (AUROC = 0.65, 95% CI = 0.54-0.75, p < 0.01). PBS and MELD scores both demonstrated a superior ability of predicting mortality risk in cirrhotic patients with bacteremia.