Clinical Features, Treatment, and Outcomes of Sepsis by Culture Status in Hospitalized Adults: A Retrospective Cohort Study

BackgroundSepsis is a major cause of morbidity and mortality worldwide, particularly in low-and middle-income countries.Despite advances in antimicrobial therapy and critical care, distinguishing culture-positive from culture-negative sepsis remains challenging and may influence antimicrobial management and clinical outcomes.Comparing the clinical characteristics, treatment patterns, and outcomes of these two groups may help improve risk assessment and optimize patient management in resource-limited settings such as Pakistan. ObjectiveThis study's objective is to compare clinical features, treatment-related variables, and in-hospital outcomes between adults with culture-negative and culture-positive sepsis, and to assess the association between culture status and in-hospital mortality after adjustment for selected potential confounders.The primary outcome was in-hospital mortality. MethodsA retrospective comparative study was conducted at Shalamar Hospital, Lahore, Pakistan, from April 2024 to April 2026, among 378 adult patients with sepsis.Patients were classified as culture-negative or culturepositive according to microbiological culture results.Demographic characteristics, comorbidities, clinical severity, infection source, laboratory parameters, treatment patterns, and in-hospital outcomes were recorded. ResultsOut of 378 patients, 269 (71.2%) had culture-negative sepsis, and 109 (28.8%) had culture-positive sepsis.In-hospital mortality was significantly higher among patients with culture-positive sepsis than among those with culture-negative sepsis (25 (22.9%) vs. 36 (13.4%); p = 0.033).Culture-positive patients had a higher frequency of quick Sequential Organ Failure Assessment (qSOFA) ≥2 compared with culture-negative patients (53 (48.6%) vs. 98 (36.4%), p = 0.038) and a higher mean SOFA score (7.3 ± 3.4 vs. 6.4 ± 3.1, p = 0.018).Serum creatinine (2.0 ± 1.3 vs. 1.7 ± 1.1 mg/dL, p = 0.035) and lactate levels (3.8 ± 2.1 vs. 3.2 ± 1.8 mmol/L, p = 0.010) were also higher among culture-positive patients.Antibiotic modification or deescalation was more frequent in culture-positive sepsis (66 (60.6%) vs. 72 (26.8%), p < 0.001).Septic shock occurred in 35 (32.1%) of culture-positive versus 54 (20.1%) of culture-negative patients (p = 0.018). ConclusionCulture-positive sepsis was associated with greater disease severity, more frequent organ dysfunction and septic shock, longer hospitalization, and higher in-hospital mortality than culture-negative sepsis.These findings should be interpreted cautiously given the retrospective design, potential residual confounding, and borderline adjusted association with mortality.Culture positivity should therefore be considered a marker associated with poorer outcomes rather than an independent cause of increased mortality.