🆕️⚡️⚡️Prospective cohort study In patients with septic shock, culture-negativity was associated with increased mortality, despite the paradoxically higher appropriateness of empirical antibiotics than culture-positive patients #idsky #medsky ccforum.biomedcentral.com/articles/10.... - ThreadSky

absteward.bsky.social • 104 days ago

🆕️⚡️⚡️Prospective cohort study
In patients with septic shock, culture-negativity was associated with increased mortality, despite the paradoxically higher appropriateness of empirical antibiotics than culture-positive patients #idsky #medsky
https://ccforum.biomedcentral.com/articles/10.1186/s13054-024-05151-3

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absteward.bsky.social•104 days ago

In all patients, culture-negative sepsis showed similar mortality to culture-positive sepsis despite lower severity of disease

dralicehan.bsky.social•104 days ago

This is why I hate the term “sepsis” - it implies an infectious etiology when the definition is based on a set of vital sign and laboratory parameters that may or may not be correlated to an infection. Can’t expect abx to help if there’s not a bacterial etiology #IDsky

jonathanrydermd.bsky.social•103 days ago

Agree. Studies of sepsis suffer greatly from their lack of specificity on what is actually being studied

kenkoonwong.bsky.social•103 days ago

I think the 2nd sentence of the conclusion of the abstract is key. "These contradictory findings suggest that the current criteria for determining the appropriateness of empirical antibiotic therapy may not be valid for culture-negative sepsis."

jonathanrydermd.bsky.social•103 days ago

Yeah I was trying to figure out how to interpret that. The challenge of course when prescribing empiric antibiotics for sepsis is you don’t know whether it’s culture positive or culture negative. I would suggest we should better define sepsis (easier said than done)

kenkoonwong.bsky.social•103 days ago

I believe the authors are aware of the unmeasured confounder that resulted in such estimate, cautioning readers that this may not mean anything 😅 OK, that's my interpretation

dralicehan.bsky.social•103 days ago

And yet, they did make this statement.

I stand by, abx unlikely to work, regardless of how quickly given, if it isn’t a bacterial etiology

andrewdesio.bsky.social•103 days ago

My head is spinning here, how did they determine appropriateness of antibiotics with negative cultures? Supposed source + patient risk factors?

It feels like we’re trying to justify 50% of hospitalized patients getting antibiotics by working backwards

dralicehan.bsky.social•103 days ago

#IDSky

idvilchez.bsky.social•103 days ago

And don't forget Viral Sepsis
https://pmc.ncbi.nlm.nih.gov/articles/PMC6170629/

absteward.bsky.social•103 days ago

Sepsis is heterogeneous syndrome #idsky #medsky

stevenmathern.bsky.social•103 days ago

and abx are beginning to fail too

brainofbpharm.bsky.social•103 days ago

Sepsis seems to just get thrown out as kind of a lazy way to say “sick,” with an underlying assumption that it’s an infection. I wouldn’t be surprised if a sizable % of physicians think sepsis IS an infection!

anniejoseph.bsky.social•104 days ago

📌

jakebakermd.bsky.social•104 days ago

Seems like culture negative sepsis might be a wide net that includes a number of non-infectious etiologies that wouldn’t be antibiotic responsive and have poor prognosis. Were they “Pulmonary origin sepsis” or organ failure resulting in pulmonary syndrome. (Hepatopulmonary, cardiopulmonary).

andrewdesio.bsky.social•104 days ago

Culture negative sepsis is probably such a variety of other things. Infections that got abx prior to culture, sure, but probably lots of other mechanisms of shock that are inadequately treated because everything is being attributed to sepsis until too late

bbiebelberg.bsky.social•104 days ago

We found very similar findings when looking at smaller cohorts a couple of years ago.

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