Mortality Associated With Severe Sepsis Not Dependent on Blood Culture Positivity or Time to Positivity

Investigators from the FABLED study report on the relationship between mortality and blood culture positivity in patients presenting to the emergency department with sepsis.

Survival at 90 days after severe sepsis was not found to be associated with blood culture positivity or time to positivity, according to the results of a study published in Open Forum Infectious Diseases.

Data were sourced from the FABLED trial ( Identifier: NCT01867905). Patients (N=315) presenting with systemic inflammatory response syndrome at emergency departments at 7 centers in Canada and the United States between 2013 and 2018 were assessed for sepsis. Outcomes through 90 days were analyzed.

The mean age of study participants was 65.3±17.7 years, 63.4% were men, and the median Charlson Comorbidity Index (CCI) score was 1 (interquartile range [IQR], 1-3).

At baseline, 102 patients had positive blood cultures prior to undergoing treatment with antimicrobial agents; 44.1% were infected with gram-negative organisms, 41.2% were infected with gram-positive organisms, 11.8% had a polymicrobial infection, and 2% had a bloodstream infection with Candida species.

Mortality at 90 days occurred among 80 patients. Patients who died were older (mean, 72.5 vs 62.9 years; P <.01); had higher CCI scores (median, 2 vs 1; P <.01); and were more likely to have dementia (16.2% vs 7.7%; P =.03), malignancy (33.8% vs 20.0%; P =.02), and a positive quick Sequential Organ Failure Assessment score (71.2% vs 54.9%; P <.01). Fewer patients who died had abnormal white blood cell counts (68.8% vs 82.1%; P =.02).

Mortality was not associated with positive blood culture at baseline (adjusted odds ratio [aOR], 0.66; 95% CI, 0.37-1.20; P =.18), positive blood culture after antimicrobial therapy (aOR, 0.79; 95% CI, 0.40-1.57; P =.51), any positive blood culture (aOR, 0.65; 95% CI, 0.36-1.18; P =.16), source of infection (aOR, 0.99; 95% CI, 0.83-1.17; P =.88), time to positivity before treatment (aOR, 1.02; 95% CI, 0.93-1.12; P =.69), or time to positivity after treatment (aOR, 0.96; 95% CI, 0.91-1.02; P =.18).

This study may have been limited by variation in laboratory practices across study sites.

These data indicated that 90-day mortality after severe sepsis was not associated with blood culture positivity or time to positivity.

Disclosure: A study author declared an affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Paquette K, Sweet D, Stenstrom R, et al. Neither blood culture positivity nor time to positivity is associated with mortality among patients presenting with severe manifestations of sepsis: The FABLED Cohort Study. Open Forum Infect Dis. Published online June 17, 2021. doi:10.1093/ofid/ofab321