{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T15:46:46Z","timestamp":1756309606543,"version":"3.40.5"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T00:00:00Z","timestamp":1689292800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>Among pediatric patients with septic shock, culture-negative septic shock (CNSS) is common but there have been limited data on its clinical characteristics and prognosis. We compared the clinical characteristics and clinical outcomes between culture-positive septic shock (CPSS) and CNSS in pediatric patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Design<\/jats:title>\n<jats:p>Retrospective single-center study.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Setting<\/jats:title>\n<jats:p>Pediatric intensive care unit (PICU) of a tertiary referral hospital.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Patients<\/jats:title>\n<jats:p>All pediatric patients who were admitted to the PICU due to septic shock between January 2010 and November 2021, except for those with fungal or viral infections and those who expired on the day of admittance to the PICU. The primary outcome was 30-day mortality and in-hospital mortality.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Interventions<\/jats:title>\n<jats:p>None.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec006\">\n<jats:title>Measurements and main results<\/jats:title>\n<jats:p>A total of 294 patients (CPSS group, n = 185 [62.9%]; CNSS group, n = 109 [37.1%]) were included. The rates of 30-day mortality and in-hospital mortality (30-day mortality 22.7% vs 22%, in-hospital mortality 29.7% vs 25.7%) were not significantly different between the CPSS group and the CNSS group. The two groups showed comparable results in clinical outcomes such as the requirement for mechanical ventilator and renal replacement therapy, PICU stay duration, and the duration of MV and vasopressor\/inotrope support. Among the CPSS group, 98 (53%) patients who were infected with multi-drug resistance (MDR) bacteria had significantly higher rates of 30-day mortality and in-hospital mortality than those infected with non-MDR bacteria.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec007\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Among pediatric patients, the CPSS group and CNSS group did not show significant differences in clinical features and mortality. Among the CPSS group, those with MDR bacteria had poorer prognosis.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0288615","type":"journal-article","created":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T17:42:35Z","timestamp":1689356555000},"page":"e0288615","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Comparison of the clinical characteristics and clinical outcomes of culture-positive septic shock and culture-negative septic shock among pediatric patients"],"prefix":"10.1371","volume":"18","author":[{"given":"Da Hyun","family":"Kim","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seong Jong","family":"Park","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2309-0494","authenticated-orcid":true,"given":"Won Kyoung","family":"Jhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,7,14]]},"reference":[{"issue":"10219","key":"pone.0288615.ref001","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/S0140-6736(19)32989-7","article-title":"Global, regional, and national sepsis incidence and mortality, 1990\u20132017: analysis for the Global Burden of Disease Study","volume":"395","author":"KE Rudd","year":"2020","journal-title":"The Lancet"},{"issue":"10","key":"pone.0288615.ref002","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1164\/rccm.201310-1875OC","article-title":"Association between source of infection and hospital mortality in patients who have septic shock","volume":"189","author":"A Leligdowicz","year":"2014","journal-title":"American journal of respiratory and critical care medicine"},{"issue":"16","key":"pone.0288615.ref003","doi-asserted-by":"crossref","first-page":"1546","DOI":"10.1056\/NEJMoa022139","article-title":"The epidemiology of sepsis in the United States from 1979 through 2000","volume":"348","author":"GS Martin","year":"2003","journal-title":"New England Journal of Medicine"},{"issue":"3","key":"pone.0288615.ref004","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1016\/j.cmi.2018.05.016","article-title":"Impact of antibiotic administration on blood culture positivity at the beginning of sepsis: a prospective clinical cohort study","volume":"25","author":"C Scheer","year":"2019","journal-title":"Clinical Microbiology and Infection"},{"issue":"11","key":"pone.0288615.ref005","doi-asserted-by":"crossref","first-page":"4851","DOI":"10.1128\/AAC.00627-10","article-title":"Systematic review and meta-analysis of the efficacy of appropriate empiric antibiotic therapy for sepsis","volume":"54","author":"M Paul","year":"2010","journal-title":"Antimicrobial agents and chemotherapy"},{"issue":"12","key":"pone.0288615.ref006","doi-asserted-by":"crossref","first-page":"2742","DOI":"10.1097\/01.CCM.0000098031.24329.10","article-title":"Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis.","volume":"31","author":"J Garnacho-Montero","year":"2003","journal-title":"Critical care medicine."},{"issue":"5","key":"pone.0288615.ref007","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/cc12896","article-title":"Characteristics and outcomes of culture-negative versus culture-positive severe sepsis.","volume":"17","author":"J Phua","year":"2013","journal-title":"Critical care."},{"key":"pone.0288615.ref008","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.ijid.2017.03.005","article-title":"Sepsis-related mortality in 497 cases with blood culture-positive sepsis in an emergency department","volume":"58","author":"J Rannikko","year":"2017","journal-title":"International Journal of Infectious Diseases"},{"issue":"2","key":"pone.0288615.ref009","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1001\/jama.1995.03520260039030","article-title":"The natural history of the systemic inflammatory response syndrome (SIRS): a prospective study.","volume":"273","author":"MS Rangel-Frausto","year":"1995","journal-title":"Jama"},{"issue":"5","key":"pone.0288615.ref010","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1364-8535-17-1001","article-title":"Unrevealing culture-negative severe sepsis.","volume":"17","author":"N de Prost","year":"2013","journal-title":"Critical care"},{"issue":"4","key":"pone.0288615.ref011","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1097\/CCM.0000000000002924","article-title":"Culture-negative septic shock compared with culture-positive septic shock: a retrospective cohort study","volume":"46","author":"S Kethireddy","year":"2018","journal-title":"Critical care medicine"},{"issue":"5","key":"pone.0288615.ref012","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1097\/MCC.0000000000000751","article-title":"Culture-negative sepsis.","volume":"26","author":"J Thorndike","year":"2020","journal-title":"Curr Opin Crit Care"},{"issue":"1","key":"pone.0288615.ref013","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13054-021-03651-0","article-title":"Comparison of culture\u2011negative and culture\u2011positive sepsis or septic shock: outcomes are more influenced by the nature of the infectious agent itself than by the samples\u2019 positivity","volume":"25","author":"R Jouffroy","year":"2021","journal-title":"Critical Care"},{"issue":"1","key":"pone.0288615.ref014","first-page":"1","article-title":"Kim WY. Characteristics and clinical outcomes of culture-negative and culture-positive septic shock: a single-center retrospective cohort study","volume":"25","author":"Kim Y-J Kim J-s","year":"2021","journal-title":"Critical Care"},{"issue":"1","key":"pone.0288615.ref015","first-page":"1","article-title":"Comparison of culture-negative and culture-positive sepsis or septic shock: a systematic review and meta-analysis","volume":"25","author":"Y Li","year":"2021","journal-title":"Critical Care"},{"key":"pone.0288615.ref016","first-page":"10","article-title":"Comparing outcomes between culture-positive and culture-negative septic shock in a PICU: A retrospective cohort study","author":"H Huang","year":"2022","journal-title":"Frontiers in Pediatrics"},{"issue":"8","key":"pone.0288615.ref017","article-title":"Association between culture-negative versus culture-positive sepsis and outcomes of patients admitted to the pediatric intensive care unit.","volume":"12","author":"TR Hazwani","year":"2020","journal-title":"Cureus."},{"issue":"8","key":"pone.0288615.ref018","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1097\/PCC.0000000000003001","article-title":"Association of Pathogen Type With Outcomes of Children Encountering Community-Acquired Pediatric Septic Shock","volume":"23","author":"D Salud","year":"2022","journal-title":"Pediatric Critical Care Medicine"},{"key":"pone.0288615.ref019","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1007\/s00134-019-05878-6","article-title":"Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children","volume":"46","author":"SL Weiss","year":"2020","journal-title":"Intensive care medicine"},{"issue":"3","key":"pone.0288615.ref020","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1111\/j.1469-0691.2011.03570.x","article-title":"Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance","volume":"18","author":"A-P Magiorakos","year":"2012","journal-title":"Clinical microbiology and infection"},{"issue":"5","key":"pone.0288615.ref021","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1097\/00003246-199605000-00004","article-title":"PRISM III: an updated Pediatric Risk of Mortality score.","volume":"24","author":"MM Pollack","year":"1996","journal-title":"Critical care medicine."},{"issue":"10","key":"pone.0288615.ref022","doi-asserted-by":"crossref","first-page":"e172352","DOI":"10.1001\/jamapediatrics.2017.2352","article-title":"Adaptation and validation of a pediatric sequential organ failure assessment score and evaluation of the sepsis-3 definitions in critically ill children","volume":"171","author":"TJ Matics","year":"2017","journal-title":"JAMA pediatrics"},{"issue":"5","key":"pone.0288615.ref023","doi-asserted-by":"crossref","first-page":"1300","DOI":"10.1213\/ANE.0000000000004072","article-title":"Culture negative and culture positive sepsis: a comparison of characteristics and outcomes.","volume":"129","author":"MJ Sigakis","year":"2019","journal-title":"Anesthesia and analgesia."},{"issue":"6","key":"pone.0288615.ref024","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1016\/j.chest.2016.08.1460","article-title":"Culture-negative severe sepsis: nationwide trends and outcomes.","volume":"150","author":"S Gupta","year":"2016","journal-title":"Chest."},{"issue":"1","key":"pone.0288615.ref025","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1097\/CCM.0000000000000663","article-title":"Elucidating the known unknowns of sepsis.","volume":"43","author":"JT Jacob","year":"2015","journal-title":"Critical Care Medicine"},{"issue":"6","key":"pone.0288615.ref026","doi-asserted-by":"crossref","first-page":"R158","DOI":"10.1186\/cc7157","article-title":"Incidence, organ dysfunction and mortality in severe sepsis: a Spanish multicentre study.","volume":"12","author":"J Blanco","year":"2008","journal-title":"Crit Care"},{"issue":"11","key":"pone.0288615.ref027","doi-asserted-by":"crossref","first-page":"S466","DOI":"10.1097\/01.CCM.0000145917.89975.F5","article-title":"Diagnosis of infection in sepsis: an evidence-based review.","volume":"32","author":"J Cohen","year":"2004","journal-title":"Critical care medicine."},{"issue":"9868","key":"pone.0288615.ref028","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1016\/S0140-6736(12)61815-7","article-title":"Sepsis definitions: time for change","volume":"381","author":"J-L Vincent","year":"2013","journal-title":"Lancet (London, England)."},{"issue":"7","key":"pone.0288615.ref029","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/j.amjmed.2003.07.005","article-title":"Inappropriate initial antimicrobial therapy and its effect on survival in a clinical trial of immunomodulating therapy for severe sepsis","volume":"115","author":"S Harbarth","year":"2003","journal-title":"The American journal of medicine"},{"key":"pone.0288615.ref030","doi-asserted-by":"crossref","first-page":"4191","DOI":"10.2147\/IDR.S334161","article-title":"Comparison of Clinical Characteristics and Outcomes Between Positive and Negative Blood Culture Septic Patients: A Retrospective Cohort Study","volume":"14","author":"L Yang","year":"2021","journal-title":"Infection and Drug Resistance"},{"key":"pone.0288615.ref031","first-page":"2121","volume-title":"Gram-negative bacteria with difficult-to-treat resistance: A moving target","author":"MN Al-Hasan","year":"2021"},{"issue":"20\u201321","key":"pone.0288615.ref032","first-page":"345","article-title":"Treatment options for carbapenem-resistant gram-negative infections.","volume":"115","author":"M Fritzenwanker","year":"2018","journal-title":"Deutsches \u00c4rzteblatt International"},{"key":"pone.0288615.ref033","doi-asserted-by":"crossref","first-page":"301","DOI":"10.2147\/IDR.S120227","article-title":"A novel combination approach of human polyclonal IVIG and antibiotics against multidrug-resistant Gram-positive bacteria.","volume":"9","author":"MM Sallam","year":"2016","journal-title":"Infection and Drug Resistance"},{"issue":"5","key":"pone.0288615.ref034","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1097\/SHK.0000000000001907","article-title":"Clinical Characteristics and Outcomes of Neutropenic Sepsis: A Multicenter Cohort Study","volume":"57","author":"SJ Na","year":"2022","journal-title":"Shock"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0288615","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T17:43:21Z","timestamp":1689356601000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0288615"}},"subtitle":[],"editor":[{"given":"Tai-Heng","family":"Chen","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2023,7,14]]},"references-count":34,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,7,14]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0288615","relation":{},"ISSN":["1932-6203"],"issn-type":[{"type":"electronic","value":"1932-6203"}],"subject":[],"published":{"date-parts":[[2023,7,14]]}}}