Neither Blood Culture Positivity nor Time to Positivity Is Associated With Mortality Among Patients Presenting With Severe Manifestations of Sepsis: The FABLED Cohort Study

Katryn Paquette¹, David Sweet², Robert Stenstrom³, Sarah N Stabler⁴, Alexander Lawandi^{5

6

7}, Murtaza Akhter⁸, Adam C Davidson⁹, Marko Gavric², Rehman Jinah², Zahid Saeed¹⁰, Koray Demir¹¹, Sassan Sangsari¹², Kelly Huang¹², Amirali Mahpour¹³, Chris Shamatutu¹⁴, Chelsea Caya¹¹, Jean-Marc Troquet¹⁵, Greg Clark¹⁵, Titus Wong¹⁶, Cedric P Yansouni^{5

6}, Matthew P Cheng^{5

6}

Affiliations

¹ Division of Neonatology, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
² Division of Critical Care Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
³ Department of Emergency Medicine, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
⁴ Department of Pharmacy Services, Surrey Memorial Hospital, Surrey, British Columbia, Canada.
⁵ Division of Infectious Diseases, McGill University Health Center, McGill University, Montreal, Quebec, Canada.
⁶ Division of Medical Microbiology, McGill University Health Center, McGill University, Montreal, Quebec, Canada.
⁷ National Institutes of Health Clinical Center, Critical Care Department, Bethesda, Maryland, USA.
⁸ Department of Emergency Medicine, Maricopa Integrated Health Center, Phoenix, Arizona, USA.
⁹ Department of Emergency Medicine, Lion's Gate Hospital, North Vancouver, British Columbia, Canada.
¹⁰ Department of Pulmonary and Critical Care Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA.
¹¹ Department of Medicine, McGill University, Montreal, Quebec, Canada.
¹² Department of Emergency Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
¹³ Division of Respirology, University of Western Ontario, London Health Sciences Center, London, Ontario, Canada.
¹⁴ Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
¹⁵ Department of Emergency Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
¹⁶ Department of Medical Microbiology, Vancouver Coastal Health, Vancouver, British Columbia, Canada.

PMID: 34307728
PMCID: PMC8294679
DOI: 10.1093/ofid/ofab321

Neither Blood Culture Positivity nor Time to Positivity Is Associated With Mortality Among Patients Presenting With Severe Manifestations of Sepsis: The FABLED Cohort Study

Katryn Paquette et al. Open Forum Infect Dis. 2021.

. 2021 Jun 17;8(7):ofab321.

doi: 10.1093/ofid/ofab321. eCollection 2021 Jul.

Authors

Affiliations

¹ Division of Neonatology, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
² Division of Critical Care Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
³ Department of Emergency Medicine, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
⁴ Department of Pharmacy Services, Surrey Memorial Hospital, Surrey, British Columbia, Canada.
⁵ Division of Infectious Diseases, McGill University Health Center, McGill University, Montreal, Quebec, Canada.
⁶ Division of Medical Microbiology, McGill University Health Center, McGill University, Montreal, Quebec, Canada.
⁷ National Institutes of Health Clinical Center, Critical Care Department, Bethesda, Maryland, USA.
⁸ Department of Emergency Medicine, Maricopa Integrated Health Center, Phoenix, Arizona, USA.
⁹ Department of Emergency Medicine, Lion's Gate Hospital, North Vancouver, British Columbia, Canada.
¹⁰ Department of Pulmonary and Critical Care Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA.
¹¹ Department of Medicine, McGill University, Montreal, Quebec, Canada.
¹² Department of Emergency Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
¹³ Division of Respirology, University of Western Ontario, London Health Sciences Center, London, Ontario, Canada.
¹⁴ Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
¹⁵ Department of Emergency Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
¹⁶ Department of Medical Microbiology, Vancouver Coastal Health, Vancouver, British Columbia, Canada.

PMID: 34307728
PMCID: PMC8294679
DOI: 10.1093/ofid/ofab321

Abstract

Background: Sepsis is a leading cause of morbidity, mortality, and health care costs worldwide.

Methods: We conducted a multicenter, prospective cohort study evaluating the yield of blood cultures drawn before and after empiric antimicrobial administration among adults presenting to the emergency department with severe manifestations of sepsis. Enrolled patients who had the requisite blood cultures drawn were followed for 90 days. We explored the independent association between blood culture positivity and its time to positivity in relation to 90-day mortality.

Results: Three hundred twenty-five participants were enrolled; 90-day mortality among the 315 subjects followed up was 25.4% (80/315). Mortality was associated with age (mean age [standard deviation] in those who died was 72.5 [15.8] compared with 62.9 [17.7] years among survivors; P < .0001), greater Charlson Comorbidity Index (2 [interquartile range {IQR}, 1-3] vs 1 [IQR, 0-3]; P = .008), dementia (13/80 [16.2%] vs 18/235 [7.7%]; P = .03), cancer (27/80 [33.8%] vs 47/235 [20.0%]; P = .015), positive quick Sequential Organ Failure Assessment score (57/80 [71.2%] vs 129/235 [54.9%]; P = .009), and normal white blood cell count (25/80 [31.2%] vs 42/235 [17.9%]; P = .02). The presence of bacteremia, persistent bacteremia after antimicrobial infusion, and shorter time to blood culture positivity were not associated with mortality. Neither the source of infection nor pathogen affected mortality.

Conclusions: Although severe sepsis is an inflammatory condition triggered by infection, its 90-day survival is not influenced by blood culture positivity nor its time to positivity.

Clinical trials registration: NCT01867905.

Keywords: bacteremia; bloodstream infection; mortality; sepsis; survival.

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References

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Neither Blood Culture Positivity nor Time to Positivity Is Associated With Mortality Among Patients Presenting With Severe Manifestations of Sepsis: The FABLED Cohort Study

Affiliations

Neither Blood Culture Positivity nor Time to Positivity Is Associated With Mortality Among Patients Presenting With Severe Manifestations of Sepsis: The FABLED Cohort Study

Authors

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Abstract

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References

Associated data

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Medical