The Diagnostic and Therapeutic Challenges of Culture Negative Sepsis

This review explores the current literature on the diagnosis and management of pediatric culture negative sepsis.

We explored logistical factors associated with culture negative sepsis, potential diagnostic tools such as biomarkers, and the limited evidence for treatment of culture negative sepsis in children. In the setting of a negative blood culture, but high clinical suspicion for bacterial infections, clinicians look to biomarkers to help guide the use of antibiotics. These biomarkers, however, are not consistently helpful. In general, procalcitonin is superior to CRP for its specificity of a bacterial infection. However, evidence shows this biomarker may better serve to rule out bacterial infection. Other studies suggest procalcitonin may be used as a method to determine the length of antibiotic therapy, but these protocols have not been standardized. Few studies look at appropriate antibiotic duration for culture negative sepsis but suggest it may be adequate to treat for 5–7 days.

Overall, culture negative sepsis remains difficult to diagnose and has limited guidance for treatment. This is an important area for future research to help limit the misuse of antibiotics in the era of growing antimicrobial resistance.