Association between positive blood culture and clinical outcomes among children treated for sepsis in the emergency department

Objective: Among children treated for sepsis in a pediatric emergency department (ED), compare clinical features and outcomes between those with blood cultures positive versus negative for a bacterial pathogen.Design: Single-center retrospective cohort study.Setting: Pediatric emergency department (ED) at a quaternary pediatric care center.Patients: Children aged 0-18 years treated for sepsis defined by the Children's Hospital Association's Improving Pediatric Sepsis Outcomes (IPSO) definition.Interventions: None.Measurements and main results: We analyzed 1307 patients treated for sepsis during the study period, of which 117 (9.0%) had blood cultures positive for a bacterial pathogen. Of children with blood culture positive sepsis, 62 (53.0%) had organ dysfunction compared to 514 (43.2%) with culture negative sepsis (adjusted odds ratio 1.56, 95% confidence interval (CI) 1.04-2.34, adjusting for age, high risk medical conditions, and time to antibiotics). Children with blood culture positive sepsis had a larger base deficit, -4 vs -1 (p < 0.01), and higher procalcitonin, 3.84 vs 0.56 ng/mL (p < 0.01).Conclusions: Children meeting the IPSO Sepsis definition with blood culture positive for a bacterial pathogen have higher rates of organ dysfunction than those who are culture negative, although our 9% rate of blood culture positivity is lower than previously cited literature from the pediatric intensive care unit.(c) 2023 Elsevier Inc. All rights reserved.

Automated summary

This study compared clinical features and outcomes between pediatric sepsis patients with blood cultures positive versus negative for bacterial pathogens. The results showed that children with blood culture positive sepsis had higher rates of organ dysfunction, a larger base deficit, and higher procalcitonin levels.