Positive Blood Cultures: A Direr Prognosis?

Sepsis accounts for 2% of hospital admissions and an estimated 17% of in-hospital deaths and is the leading cause of death in critically ill patients. Blood cultures represent an important diagnostic tool in those who are clinically suspected of having sepsis. We conducted a retrospective study of all emergency department (ED) patients who were given the diagnosis code for sepsis during 1 month. We compared admission to the intensive care unit (ICU), length of hospital stay, and outcomes for patients with positive vs negative blood cultures. We also characterized the organisms and possible sources for patients with positive blood cultures. A total of 54 patients with the code for sepsis were analyzed. Thirty-four patients had negative cultures and 20 had positive cultures. The most common organisms recovered in the positive cultures were beta hemolytic streptococci (3), Escherichia coli (3), and viridans group streptococci (3). Twenty-five (73.5%) of the patients with negative cultures were admitted to intensive care vs 18 (90%, P = .335) patients with positive blood cultures. Eleven (32%) patients with negative blood cultures and six (30%, P = .9998) patients with positive blood cultures expired during their hospital stay. For the patients with positive cultures, the average length of stay was 5.6 days (range 0-23 days; SD 5.44), compared with 6.5 days (range 0-29 days; SD 8.28) for those without positive cultures. The suspected sources of infection in patients with positive cultures included gastrointestinal (3), respiratory (3), urinary tract (3), unknown (5), and other (6). Our data did not show statistically significant differences in outcomes between patients with positive blood cultures and those with negative cultures. Therefore, positive blood cultures may not be a predictor of mortality or ICU admission in patients who meet clinical criteria for sepsis upon arrival to the ED.