369 - Culture Positive versus Culture Negative Pediatric Sepsis: An Analysis of Key Characteristics and Outcomes

Poster Number: 369

Talia Kozlowski, University of Maryland Children's Hospital, Baltimore, MD, United States; Amal Malik, University of Maryland Medical Center, Baltimore, MD, United States; Natasha Smith, University of Maryland Medical Center, Baltimore, MD, United States; Getachew Teshome, univ of Maryland School of Medicine, Baltimore, MD, United States

Background: Pediatric sepsis accounts for 80,000 hospital admissions and 5,000 deaths in the United States annually. Despite increased efforts to better identify and diagnose sepsis, little is known on the differences between culture positive and culture negative pediatric sepsis. 

Objective: The purpose of this study was to compare characteristics and outcomes of pediatric patients identified on the sepsis screen based on their ultimate culture results. This aim may assist in narrowing our sepsis criteria to reduce unnecessary antibiotic use and prolonged hospitalizations.

Design/Methods: We conducted a retrospective study from January 2017 to December 2020 of patients aged 0-21 years old who met SIRS criteria within 24 hours of presenting to our facility, including those transferred from an OSH. Characteristics compared between the two groups included initial vital signs triggering the sepsis screen, presenting symptoms such as respiratory, cardiac, GI, and skin and soft tissue complaints, and laboratory values, namely complete blood count and differential, CRP, and lactate. Outcomes included ICU admission, use of pressors, number of fluid boluses, final disposition, and presence of organ dysfunction.

Results: One hundred and seventy-four patients ultimately met inclusion criteria. Sixty-one (35%) patients had positive blood, urine, wound, or cerebrospinal fluid cultures. Patients with culture positive sepsis had significantly higher CRP values, and longer hospital stays compared to those patients with negative cultures. Patients with culture negative sepsis were significantly more likely to be male, present with skin and soft tissue symptoms, and receive more fluid boluses than those with culture positive sepsis. There were no statistically significant differences in initial vital signs, WBC count, pressor use, or organ dysfunction.Conclusion(s): Despite several significant characteristic and outcome differences between culture positive and culture negative pediatric sepsis, few are clinically useful in narrowing criteria to diagnose sepsis more accurately within the first 24 hours of presentation and reduce unnecessary antibiotic use.
Talia.KozlowskiCV.pdf
Lab Values and Outcomes of Culture Positive versus Culture Negative Pediatric Sepsis