Gopalakrishnan RM, Nair AR, Sudhakar A, Jayant A, Balachandran R, Neema PK, Kumar RK. Culture-negative sepsis after pediatric cardiac surgery: Incidence and outcomes.
Ann Pediatr Cardiol 2022;
15:442-446. [PMID:
37152519 PMCID:
PMC10158468 DOI:
10.4103/apc.apc_37_22]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 03/02/2023] Open
Abstract
Background
Significant proportion of congenital heart surgery (CHS) children exhibit sepsis, but have negative blood culture and defined "culture negative sepsis (CNS)."
Aims and Objectives
Retrospective analysis of CNS patients undergoing CHS.
Material and Methods
437 consecutive CHS children grouped as controls (antibiotic prophylaxis), CNS, and culture positive sepsis (CPS).
Results
Incidences of CNS and CPS were 16% and 7%. Median mechanical ventilation (MV) in hours among CPS, CNS, and control was 116 (45-271), 63 (23-112), and 18 (6-28) (P < 0.001), respectively. Multivariable linear regression identified CPS (median ratio: 3.1 [2.3-4.1], P < 0.001), CNS (median ratio: 5.6 [3.7-8.4], P < 0.001), and weight (kg) (median ratio: 0.98 [0.96-0.99], P = 0.009) as associations of MV. Intensive care unit (ICU) stay (hours) was 192 (120-288) in CNS, 288 (156-444) in CPS, and 72 (48-120) in controls (P < 0.0001). Multivariable linear regression showed CNS (median ratio: 2.4 [2.0-2.9], P< 0.001) CPS (median ratio: 3.3 [2.5-4.4], P < 0.001), and weight (median ratio: 0.98 [0.97-0.99], P ≤ 0.001) prolonging ICU stay. Mortality was 10.7%, 2.9% and 1.2% in CPS, CNS, and control (P = 0.03). Multivariable regression identified CPS an independent predictor of mortality with odds ratio 8.6 (1.7-44.9; P = 0.010). 11.26% patients in CNS and 79.3% in CPS received antibiotics for more than 10 days.
Conclusion
Incidence of CNS was 16%; duration of MV and ICU stay and mortality was significantly less in CNS than CPS patients.
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