{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T17:48:55Z","timestamp":1777312135519,"version":"3.51.4"},"reference-count":48,"publisher":"Hamad bin Khalifa University Press (HBKU Press)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024]]},"abstract":"Introduction: Comparatively, culture-negative septic shock or septic shock (CNSS) is frequently observed among pediatric patients, contrasting with the more distinct clinical profile and prognosis of post-surgical septic shock (CPSS). However, limited data are available on the outcomes of CNSS in comparison to CPSS in pediatric patients. This study seeks to conduct a systematic review and meta-analysis of existing literature to comprehensively compare outcomes between CNSS and CPSS in pediatric patients.<\/jats:p>\n Methods: Electronic databases, such as PubMed, CINAHIL, and EMBASE, were systematically searched up to January 15, 2024, using predefined terms. We included all studies that compared outcomes between CPSS and CNSS in pediatric patients. The primary outcome evaluated in this study was all-cause mortality. Secondary outcomes included length of hospitalization, length of intensive care unit (ICU) stay, and duration of mechanical ventilation (all measured in days).<\/jats:p>\n \n Results: Among the initially identified 1328 articles, six studies involving 2511 pediatric patients met the inclusion criteria and were part of this meta-analysis study. The pooled analysis revealed no significant differences in all-cause mortality (odds ratio: 1.26, 95% confidence interval (CI): 0.93 to 1.70,\n p<\/jats:italic>\n = 0.14), length of ICU stay (mean difference (MD): 0.18, 95% CI: -0.33 to 0.68,\n p<\/jats:italic>\n = 0.50), and duration of mechanical ventilation (MD: -0.74, 95% CI: -2.46 to 0.98,\n p<\/jats:italic>\n -value = 0.40) between CPSS and CNSS. However, the length of hospital stay was longer in CPSS compared to CNSS (MD: 7.38, 95% CI: 5.50 to 9.27,\n p<\/jats:italic>\n < 0.0001).\n <\/jats:p>\n Conclusion: Approximately 26.56% of pediatric septic cases were culture-positive. There were no statistically significant differences in mortality, ICU stay, and duration of mechanical ventilation between CPSS and CNSS. However, hospital stay was prolonged by more than 7 days in culture-positive cases. Further multicenter studies are warranted to validate these findings and explore additional presentation characteristics.<\/jats:p>","DOI":"10.5339\/qmj.2024.32","type":"journal-article","created":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T02:33:01Z","timestamp":1722997981000},"source":"Crossref","is-referenced-by-count":2,"title":["Comparison of clinical outcomes between culture-positive and culture-negative sepsis or septic shock pediatrics patients: A systematic review and meta-analysis"],"prefix":"10.5339","volume":"2024","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-2496-8290","authenticated-orcid":true,"given":"Rahil","family":"Khowaja","sequence":"first","affiliation":[{"name":"School of Medicine, Swansea University, Swansea, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fazila","family":"Karimi","sequence":"additional","affiliation":[{"name":"School of Public Health, SZABIST University, Karachi, Pakistan*Correspondence: Rahil Khowaja Khowajarahil16@gmail.com"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3277","reference":[{"issue":"(10):","key":"CIT0001","series-title":"Transl Pediatrics","first-page":"2646","article-title":"Challenges and Solutions in translating sepsis guidelines into practice in resource-limited settings","volume":"10","author":"Ranjit\n \nS","year":"2021;"},{"key":"CIT0002","series-title":"Intensive Care Med","first-page":"10\u201367","article-title":"Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children","volume":"46","author":"Weiss\n \nSL","year":"2020;"},{"issue":"(6):","key":"CIT0003","series-title":"J Intensive Care Med","first-page":"753\u201363","article-title":"Latin American consensus on the management of sepsis in children: Sociedad latinoamericana de cuidados intensivos pedi\u00e1tricos [Latin American Pediatric Intensive Care Society] (SLACIP) Task Force: Executive summary","volume":"37","author":"Fern\u00e1ndez-Sarmiento\n \nJ","year":"2022;"},{"key":"CIT0004","series-title":"Front Pediatrics","first-page":"1001565","article-title":"Comparing outcomes between culture-positive and culture-negative septic shock in a PICU: A retrospective cohort study","volume":"10","author":"Huang\n \nH","year":"2022;"},{"issue":"(3):","key":"CIT0005","series-title":"Clin Microbiol Infect","first-page":"326\u201331","article-title":"Impact of antibiotic administration on blood culture positivity at the beginning of sepsis: A prospective clinical cohort study","volume":"25","author":"Scheer\n \nCS","year":"2019;"},{"issue":"(12):","key":"CIT0006","series-title":"Crit Care Med","first-page":"2742\u201351","article-title":"Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis","volume":"31","author":"Garnacho-Montero\n \nJ","year":"2003;"},{"issue":"(5):","key":"CIT0007","series-title":"Crit Care","first-page":"1\u20132","article-title":"Characteristics and outcomes of culture-negative versus culture-positive severe sepsis","volume":"17","author":"Phua\n \nJ","year":"2013;"},{"issue":"(2):","key":"CIT0008","series-title":"JAMA","first-page":"117\u201323","article-title":"The natural history of the systemic inflammatory response syndrome (SIRS): A prospective study","volume":"273","author":"Rangel-Frausto\n \nMS","year":"1995;"},{"issue":"(2):","key":"CIT0009","series-title":"Cureus","first-page":"e35416","article-title":"Comparison of clinical outcomes between culture-positive and culture-negative sepsis and septic shock patients: A meta-analysis","volume":"15","author":"Afzal\n \nMS","year":"2023;"},{"key":"CIT0010","series-title":"BMC Med Res Methodol","first-page":"135","article-title":"Estimating the sample mean and standard deviation from the sample size, median, range and\/or interquartile range","volume":"14","author":"Wan\n \nX","year":"2014;"},{"key":"CIT0011","series-title":"J Pediatrics","first-page":"113718","article-title":"Characteristics and outcomes of culture-positive and culture-negative pediatric sepsis","volume":"263","author":"Baker\n \nAH","year":"2023;"},{"key":"CIT0012","series-title":"Am J Emerg Med","first-page":"13\u20137","article-title":"Association between positive blood culture and clinical outcomes among children treated for sepsis in the emergency department","volume":"76","author":"Clemens\n \nN","year":"2024;"},{"issue":"(8):","key":"CIT0013","series-title":"Cureus","first-page":"e9981","article-title":"Association between culture-negative versus culture-positive sepsis and outcomes of patients admitted to the pediatric intensive care unit","volume":"12","author":"Hazwani\n \nTR","year":"2020;"},{"issue":"(7):","key":"CIT0014","series-title":"PLoS One","first-page":"e0288615","article-title":"Comparison of the clinical characteristics and clinical outcomes of culture-positive septic shock and culture-negative septic shock among pediatric patients","volume":"18","author":"Kim\n \nDH","year":"2023;"},{"issue":"(8):","key":"CIT0015","series-title":"Pediatric Crit Care Med","first-page":"635\u201345","article-title":"Association of pathogen type with outcomes of children encountering community-acquired pediatric septic shock","volume":"23","author":"Salud\n \nD","year":"2022;"},{"issue":"(6):","key":"CIT0016","series-title":"Chest","first-page":"1251\u20139","article-title":"Culture-negative severe sepsis: Nationwide trends and outcomes","volume":"150","author":"Gupta\n \nS","year":"2016;"},{"issue":"(6):","key":"CIT0017","series-title":"Crit Care","first-page":"R158","article-title":"Incidence, organ dysfunction and mortality in severe sepsis: A Spanish multicentre study","volume":"12","author":"Blanco\n \nJ","year":"2008;"},{"issue":"(11):","key":"CIT0018","series-title":"Crit Care Med","first-page":"S466\u201394","article-title":"Diagnosis of infection in sepsis: An evidence-based review","volume":"32","author":"Cohen\n \nJ","year":"2004;"},{"issue":"(1):","key":"CIT0019","series-title":"Crit Care","first-page":"167","article-title":"Comparison of culture-negative and culture-positive sepsis or septic shock: A systematic review and meta-analysis","volume":"25","author":"Li\n \nY","year":"2021;"},{"issue":"(12):","key":"CIT0020","series-title":"Crit Care Med","first-page":"2742\u201351","article-title":"Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis","volume":"31","author":"Garnacho-Montero\n \nJ","year":"2003;"},{"issue":"(7):","key":"CIT0021","series-title":"Am J Med","first-page":"529\u201335","article-title":"Inappropriate initial antimicrobial therapy and its effect on survival in a clinical trial of immunomodulating therapy for severe sepsis","volume":"115","author":"Harbarth\n \nS","year":"2003;"},{"issue":"(6):","key":"CIT0022","series-title":"Chest","first-page":"1251\u20139","article-title":"Culture-negative severe sepsis: Nationwide trends and outcomes","volume":"150","author":"Gupta\n \nS","year":"2016;"},{"key":"CIT0023","series-title":"Infect Drug Resist","first-page":"4191","article-title":"Comparison of clinical characteristics and outcomes between positive and negative blood culture septic patients: A retrospective cohort study","volume":"14","author":"Yang\n \nL","year":"2021;"},{"key":"CIT0024","series-title":"J Pediatr","first-page":"87\u201398","article-title":"Septic shock in pediatrics: The state-of-the-art","volume":"96","author":"Garcia\n \nPC","year":"2020;"},{"issue":"(10):","key":"CIT0001","series-title":"Transl Pediatrics","first-page":"2646","article-title":"Challenges and Solutions in translating sepsis guidelines into practice in resource-limited settings","volume":"10","author":"Ranjit\n 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\nH","year":"2022;"},{"issue":"(3):","key":"CIT0005","series-title":"Clin Microbiol Infect","first-page":"326\u201331","article-title":"Impact of antibiotic administration on blood culture positivity at the beginning of sepsis: A prospective clinical cohort study","volume":"25","author":"Scheer\n \nCS","year":"2019;"},{"issue":"(12):","key":"CIT0006","series-title":"Crit Care Med","first-page":"2742\u201351","article-title":"Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis","volume":"31","author":"Garnacho-Montero\n \nJ","year":"2003;"},{"issue":"(5):","key":"CIT0007","series-title":"Crit Care","first-page":"1\u20132","article-title":"Characteristics and outcomes of culture-negative versus culture-positive severe sepsis","volume":"17","author":"Phua\n \nJ","year":"2013;"},{"issue":"(2):","key":"CIT0008","series-title":"JAMA","first-page":"117\u201323","article-title":"The natural history of the systemic inflammatory response syndrome (SIRS): A prospective study","volume":"273","author":"Rangel-Frausto\n \nMS","year":"1995;"},{"issue":"(2):","key":"CIT0009","series-title":"Cureus","first-page":"e35416","article-title":"Comparison of clinical outcomes between culture-positive and culture-negative sepsis and septic shock patients: A meta-analysis","volume":"15","author":"Afzal\n \nMS","year":"2023;"},{"key":"CIT0010","series-title":"BMC Med Res Methodol","first-page":"135","article-title":"Estimating the sample mean and standard deviation from the sample size, median, range and\/or interquartile range","volume":"14","author":"Wan\n \nX","year":"2014;"},{"key":"CIT0011","series-title":"J Pediatrics","first-page":"113718","article-title":"Characteristics and outcomes of culture-positive and culture-negative pediatric sepsis","volume":"263","author":"Baker\n \nAH","year":"2023;"},{"key":"CIT0012","series-title":"Am J Emerg Med","first-page":"13\u20137","article-title":"Association between 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shock","volume":"23","author":"Salud\n \nD","year":"2022;"},{"issue":"(6):","key":"CIT0016","series-title":"Chest","first-page":"1251\u20139","article-title":"Culture-negative severe sepsis: Nationwide trends and outcomes","volume":"150","author":"Gupta\n \nS","year":"2016;"},{"issue":"(6):","key":"CIT0017","series-title":"Crit Care","first-page":"R158","article-title":"Incidence, organ dysfunction and mortality in severe sepsis: A Spanish multicentre study","volume":"12","author":"Blanco\n \nJ","year":"2008;"},{"issue":"(11):","key":"CIT0018","series-title":"Crit Care Med","first-page":"S466\u201394","article-title":"Diagnosis of infection in sepsis: An evidence-based review","volume":"32","author":"Cohen\n \nJ","year":"2004;"},{"issue":"(1):","key":"CIT0019","series-title":"Crit Care","first-page":"167","article-title":"Comparison of culture-negative and culture-positive sepsis or septic shock: A systematic review and meta-analysis","volume":"25","author":"Li\n 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