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Epidemiological Differences Between Sepsis Syndrome With Bacteremia and Culture-Negative Sepsis

Published online by Cambridge University Press:  02 January 2015

Concepción Fariñas-Álvarez ,
M. Carmen Fariñas ,
Carlos Fernández-Mazarrasa ,
Javier Llorca  and
Miguel Delgado-Rodríguez
Concepción Fariñas-Álvarez*
Affiliation:
Division of Preventive Medicine and Public Health, University of Cantabria School of Medicine, Santander, Spain
M. Carmen Fariñas
Affiliation:
Infectious Diseases Unit, Hospital Universitario “Marqués de Valdecilla,”, Santander, Spain
Carlos Fernández-Mazarrasa
Affiliation:
Service of Microbiology, Hospital Universitario “Marqués de Valdecilla,”, Santander, Spain
Javier Llorca
Affiliation:
Division of Preventive Medicine and Public Health, University of Cantabria School of Medicine, Santander, Spain
Miguel Delgado-Rodríguez
Affiliation:
Division of Preventive Medicine and Public Health, University of Cantabria School of Medicine, Santander, Spain
*
Division of Preventive Medicine and Public Health, University of Cantabria School of Medicine, Av Cardenal Herrera Oria s/n, 39011-Santander, Spain
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Abstract

Objective:

To explore the association of putative disease markers and potential risk factors with the nosocomial sepsis syndrome.

Design:

Prospective case-control study matched for gender, age, and length of preinfection hospital stay.

Setting:

1,200-bed tertiary-care center in Spain.

Patients:

Cases were selected using the sepsis syndrome criteria of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference and were divided into three groups: sepsis with bacteremia (109 cases), sepsis with positive culture other than blood (122 cases), and sepsis with negative culture (115 cases without documented infection but with sepsis syndrome, clinically suspected infection, and empirical antibiotic treatment). Controls were randomly selected from the daily list of inpatients. Data were collected prospectively. Crude and multiple-risk-factor-adjusted odds ratios and their 95% confidence intervals were computed using conditional logistic regression analysis.

Results:

Presence of coma in the 48 hours before sepsis, intensive care unit (ICU) stay, and decreased serum albumin levels at admission were common epidemiological markers identified for the three groups of cases. Having a central venous catheter was the main healthcare-related risk factor for bacteremia. ICU stay and nasogastric tube were the main risk factors for sepsis with positive culture other than blood. Coma within 48 hours before sepsis and the need of intensive care were the only two markers identified for culture-negative sepsis.

Conclusion:

Culture-negative sepsis does not behave like culture-positive sepsis, and this may imply that implementation of preventive measures to decrease the risk of bacteremia may not decrease the risk of sepsis syndrome.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 21 , Issue 10 , October 2000 , pp. 639 - 644
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2000

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