372 - Is culture negative sepsis a separate phenotype? Positive blood culture and organ dysfunction in pediatric sepsis.

Poster Number: 372
Publication Number: 372.312

Nancy Clemens, Cincinnati Children's Hospital Medical Center, Ludlow, KY, United States; Michelle Eckerle, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Paria M. Wilson, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Holly Depinet, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States; Yin Zhang, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: There is no consensus definition for pediatric sepsis, which can be difficult to accurately identify on presentation in the pediatric emergency department (PED). While treatment-based definitions of sepsis are common, they represent a heterogeneous patient population, and only a minority demonstrate clear invasive bacterial infection (ie, positive blood culture).  It is unknown whether sepsis in blood culture positive children represents a separate phenotype from culture negative sepsis.  

Objective: To compare outcomes and features of blood culture positive vs culture negative sepsis.

Design/Methods: We performed a retrospective cohort study of children age 0-18 years treated for sepsis in a single PED from January 2017 to March 2021. Sepsis was defined by the Children’s Hospital Association’s Improving Pediatric Sepsis Outcomes (IPSO) “IPSO Sepsis” definition: either a standalone ICD-10 code for severe sepsis/septic shock or the receipt of treatment-based criteria (blood culture obtained AND antibiotics delivered AND at least two fluid boluses PLUS one of ICU admission, lactate ordered, vasopressors administered, or an ICD-10 code for sepsis assigned). The primary outcome was organ dysfunction as defined by modified Goldstein criteria. Secondary outcomes were clinical and laboratory predictors of blood culture positivity.  We used multivariate logistic regression to determine the relationship between blood culture positivity and organ dysfunction.

Results: 1307 patients were treated for sepsis during study period, of which 117 (9.0%) were blood culture positive. 62 (53.0%) of children with culture positive sepsis had organ dysfunction compared to 514 (43.2%) with culture negative sepsis (adjusted odds ratio 1.54, 95% confidence interval 1.01-2.17, adjusting for age, race, high risk medical condition, and time to antibiotics).  Children with culture positive sepsis had a higher base deficit, -4 vs -1 (p < 0.01), and procalcitonin, 3.84 vs 0.56 ng/mL (p < 0.01). Conclusion(s): Children with culture positive sepsis have higher rates of organ dysfunction than children meeting the IPSO sepsis definition who are culture negative, although our 9% rate of blood culture positivity is lower than previously cited ICU literature. Early laboratory predictors of blood culture positivity may help physicians appropriately identify children at higher risk of organ dysfunction and guide tailored treatment to mitigate morbidity.
Nancy Clemens CV.pdf