369 - Characteristics and Outcomes of Culture-Positive and Culture-Negative Pediatric Sepsis: A Retrospective Cohort Study

Pediatric sepsis is a leading cause of morbidity, mortality, and healthcare utilization in children worldwide. Although prompt initiation of antibiotics is a mainstay of goal-directed sepsis therapy, a bacterial pathogen is isolated in only 25-65% of cases. The clinical characteristics of pediatric culture-negative septic shock are poorly defined. While there is some evidence that pediatric patients with culture-negative sepsis have better outcomes, the existing literature results are mixed.

Objective:

To compare the outcomes of pediatric septic shock among patients with culture-positive and culture-negative sepsis and to determine if there are differentiating markers of disease severity between these two populations during their initial presentation and emergency department stay.

Design/Methods:

This is a retrospective cohort study of pediatric patients ≤ 21 years of age with severe sepsis or septic shock presenting to the emergency department (ED) of a quaternary care, free-standing children’s hospital from June 1, 2017 to June 5, 2019.

Results:

There were 235 patients who met criteria for severe sepsis or septic shock. Of these, 139 (59.1%) had culture-negative sepsis and 96 (40.9%) had culture-positive sepsis. There were no differences in patient demographics between culture-negative sepsis and culture-positive sepsis except that severe neurologic dysfunction was more common among those with positive cultures. In the adjusted multivariable model, children with culture-negative sepsis had more intensive care unit (ICU)-free days than those with culture-positive sepsis. There were no differences in hospital-free days or mortality. On initial presentation, there were no differences in fever, hypothermia, tachycardia, tachypnea, or hypotension between the two groups. There were also no differences in the proportion of patients receiving any of the following interventions in the emergency department: antibiotics, intravenous fluids, vasopressors, cardiopulmonary resuscitation, or intubation, nor times to any of these interventions.

Conclusion(s):

Our findings suggest that culture-negative sepsis constitutes a substantial proportion of pediatric septic shock. Culture-negative and culture-positive sepsis patients present similarly on arrival to the emergency department and both groups are treated similarly by providers. Patients with culture-negative sepsis had more ICU-free days than those with culture-positive sepsis, although differences in hospital length of stay and mortality were not observed.