{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T13:04:41Z","timestamp":1761224681709,"version":"build-2065373602"},"reference-count":20,"publisher":"Danish Medical Association","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dan Med J"],"abstract":"<jats:p>INTRODUCTION. A prevalent approach in sepsis research is pairing obtained cultures with antibiotic treatment to identify suspected infections. However, cultures are insensitive and nonspecific. Therefore, the present study aimed to examine the proportion of patients with infections admitted to an emergency department (ED) with and without having cultures obtained and to estimate 28-day mortality and prognostic factors of mortality according to culture status.\n\nMETHODS. We conducted a secondary analysis of prospectively collected data from adult ED patients with suspected or documented infections (1 October 2017 \u2013 31 March 2018). Patients receiving both cultures and antibiotics were compared to those treated solely with antibiotics. Logistic regression analyses assessed mortality differences.\n\nRESULTS. Among 2,055 patients, 1,441 (70.1%) had at least one culture obtained in addition to antibiotic treatment. Among patients without cultures, 163 (26.6%) had a Sequential Organ Failure Assessment score (SOFA) \u2265 2 on admission, compared to 528 (36.6%) among patients with cultures obtained (difference: 5.7-14.3). The 28-day mortality was 7.3% and 7.7%, respectively (difference: \u20132.1-2.9). Age, SOFA and the Charlson Comorbidity Index were the most important prognostic factors in both groups.\n\nCONCLUSIONS. Defining suspected infections using cultures and antibiotics may introduce bias in sepsis research. Data sources relying on these criteria should be validated to examine their applicability.\n\nFUNDING. The Region Zealand Health Research Foundation and the Naestved, Slagelse and Ringsted Hospital Research Fund.\n\nTRIAL REGISTRATION. Not relevant.<\/jats:p>","DOI":"10.61409\/a03250219","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T06:47:32Z","timestamp":1759906052000},"page":"1-9","source":"Crossref","is-referenced-by-count":0,"title":["Sepsis research is hampered by the lack of a clear definition of suspected infection"],"prefix":"10.61409","author":[{"given":"Lana","family":"Chafranska","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rune Hus\u00e5s","family":"S\u00f8rensen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Osama Bin","family":"Abdullah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas Andersen","family":"Schmidt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Finn Erland","family":"Nielsen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"40208","published-online":{"date-parts":[[2025]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-810. https:\/\/doi.org\/10.1001\/jama.2016.0287","DOI":"10.1001\/jama.2016.0287"},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction\/failure. Intensive Care Med. 1996;22(7):707-710. https:\/\/doi.org\/10.1007\/BF01709751","DOI":"10.1007\/BF01709751"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis: for The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):762-774. https:\/\/doi.org\/10.1001\/jama.2016.0288","DOI":"10.1001\/jama.2016.0288"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):e1063-e1143. https:\/\/doi.org\/10.1097\/CCM.0000000000005337","DOI":"10.1097\/CCM.0000000000005337"},{"key":"ref4","unstructured":"Abdullah OB. Sepsis in an emergency department setting: prognosis, incidence and validation of new criteria for identification of patients with sepsis [PhD thesis]. Odense, Denmark: University of Southern Denmark, Faculty of Health Sciences, 2021. https:\/\/doi.org\/10.21996\/88wr-mh20 (Jun 2025)"},{"key":"ref5","unstructured":"World Health Organization. Global report on the epidemiology and burden of sepsis. Current evidence, identifying gaps and future directions. Geneva: World Health Organization, 2020. www.who.int\/publications\/i\/item\/9789240010789"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Mariansdatter SE, Eiset AH, S\u00f8gaard KK, Christiansen CF. Differences in reported sepsis incidence according to study design: a literature review. BMC Med Res Methodol. 2016;16(1):137. https:\/\/doi.org\/10.1186\/s12874-016-0237-9","DOI":"10.1186\/s12874-016-0237-9"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Cassini A, Fleischmann-Struzek C, Naghavi M, et al. Future directions and priorities in sepsis epidemiology research: a call for action. Bull World Health Organ. 2021;99(5):398-401. https:\/\/doi.org\/10.2471\/BLT.20.276709","DOI":"10.2471\/BLT.20.276709"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Litell JM, Guirgis F, Driver B, et al. Most emergency department patients meeting sepsis criteria are not diagnosed with sepsis at discharge. Acad Emerg Med. 2021;28(7):745-752. https:\/\/doi.org\/10.1111\/acem.14265","DOI":"10.1111\/acem.14265"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Duncan CF, Youngstein T, Kirrane MD, et al. Diagnostic challenges in sepsis. Curr Infect Dis Rep. 2021;23(12):22. https:\/\/doi.org\/10.1007\/s11908-021-00765-y","DOI":"10.1007\/s11908-021-00765-y"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Lindner HA, Schamoni S, Kirschning T, et al. Ground truth labels challenge the validity of sepsis consensus definitions in critical illness. J Transl Med. 2022;20(1):27. https:\/\/doi.org\/10.1186\/s12967-022-03228-7","DOI":"10.1186\/s12967-022-03228-7"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Mellhammar L, El\u00e9n S, Ehrhard S, et al. New, useful criteria for assessing the evidence of infection in sepsis research. Crit Care Explor. 2022;4(5):e0697. https:\/\/doi.org\/10.1097\/CCE.0000000000000697","DOI":"10.1097\/CCE.0000000000000697"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"O'Neal CS, Hamer D, Musso MW, et al. Retrospective identification of infection in the emergency department: a significant challenge in sepsis clinical trials. Am J Med Sci. 2022;364(2):163-167. https:\/\/doi.org\/10.1016\/j.amjms.2022.02.008","DOI":"10.1016\/j.amjms.2022.02.008"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41(2):580-637. https:\/\/doi.org\/10.1097\/CCM.0b013e31827e83af","DOI":"10.1097\/CCM.0b013e31827e83af"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"IDSA Sepsis Task Force. Infectious Diseases Society of America (IDSA) position statement: why IDSA did not endorse the Surviving Sepsis Campaign guidelines. Clin Infect Dis. 2018;66(10):1631-1635. https:\/\/doi.org\/10.1093\/cid\/cix997","DOI":"10.1093\/cid\/cix997"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"Markovic MT, Pedersen C, Gottfredsson M, et al. Epidemiology of community-acquired sepsis in the Faroe Islands - a prospective observational study. Infect Dis (Lond). 2019;51(1):38-49. https:\/\/doi.org\/10.1080\/23744235.2018.1511056","DOI":"10.1080\/23744235.2018.1511056"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"Henriksen DP, Laursen CB, Jensen TG, et al. Incidence rate of community-acquired sepsis among hospitalized acute medical patients: a population-based survey. Crit Care Med. 2015;43(1):13-21. https:\/\/doi.org\/10.1097\/CCM.0000000000000611","DOI":"10.1097\/CCM.0000000000000611"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"Fleischmann-Struzek C, Rudd K. Challenges of assessing the burden of sepsis. Med Klin Intensivmed Notfmed. 2023;118(suppl 2):68-74. https:\/\/doi.org\/10.1007\/s00063-023-01088-7","DOI":"10.1007\/s00063-023-01088-7"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Vincent JL. The clinical challenge of sepsis identification and monitoring. PLoS Med. 2016;13(5):e1002022. https:\/\/doi.org\/10.1371\/journal.pmed.1002022","DOI":"10.1371\/journal.pmed.1002022"},{"key":"ref19","unstructured":"U.S Department of Health and Human Services. Centers for Disease Control and Prevention. Hospital toolkit for adult sepsis surveillance. Centers for Disease Control and Prevention, 2018. https:\/\/stacks.cdc.gov\/view\/cdc\/132387 (Jun 2025)"}],"container-title":["Danish Medical Journal"],"original-title":[],"deposited":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T12:40:39Z","timestamp":1761223239000},"score":1,"resource":{"primary":{"URL":"https:\/\/ugeskriftet.dk\/dmj\/A03250219"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025]]},"references-count":20,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.61409\/a03250219","relation":{},"ISSN":["2245-1919"],"issn-type":[{"type":"electronic","value":"2245-1919"}],"subject":[],"published":{"date-parts":[[2025]]}}}