One can falsely assume that it is well known that
bacteremia is associated with higher mortality in
sepsis. Only a handful of studies specifically focus on the comparison of culture-negative and culture-positive
sepsis with different conclusions depending on study design. The aim of this study was to describe outcome for
critically ill patients with either culture-positive or -negative
sepsis in a clinical review. We also aimed to identify subphenotypes of
sepsis with culture status included as candidate clinical variables. Out of 784 patients treated in
intensive care with a
sepsis diagnosis, blood cultures were missing in 140 excluded patients and 95 excluded patients did not fulfill a
sepsis diagnosis. Of 549 included patients, 295 (54%) had
bacteremia, 90 (16%) were non-bacteremic but with relevant pathogens detected and in 164 (30%) no relevant pathogen was detected. After adjusting for confounders, 90-day mortality was higher in bacteremic patients, 47%, than in non-bacteremic patients, 36%, p = 0.04. We identified 8 subphenotypes, with different mortality rates, where pathogen detection in microbial samples were important for subphenotype distinction and outcome. In conclusion, bacteremic patients had higher mortality than their non-bacteremic counter-parts and
bacteremia is more common in
sepsis when studied in a clinical review. For reducing population heterogeneity and improve the outcome of trials and treatment for
sepsis, distinction of subphenotypes might be useful and pathogen detection an important factor.