尿脓毒症患者血培养阳性与阴性的临床特征 差异

Differences in Clinical Characteristics between Patients with Urosepsis with Positive and Negative Blood Cultures

摘要: 目的：探讨重症尿脓毒症患者血培养阴性与阳性的临床特征差异，为基于血培养结果的尿脓毒症临床诊治提供依据。方法：回顾性分析2021年1月~2024年12月我院重症医学二科收治的62例尿脓毒症患者，根据血培养结果分为血培养阴性与阳性组，对两组患者的基线资料、感染指标、脏器功能、干预手段及临床预后进行比较。结果：两组患者的基础伴随疾病差异无统计学意义(P > 0.05)。与血培养阴性组相比，血培养阳性组患者心率更快、序贯器官衰竭评估(sequential organ failure assessment, SOFA)评分及尿素氮水平更高，而血小板水平更低(P均<0.05)；此外，血培养阳性组血管活性药物联合使用率、去甲肾上腺素当量及去甲肾最大剂量均显著高于阴性组(P均<0.05)。结论：尿源性脓毒症患者的血培养结果差异可影响其临床特征，主要体现在心率、SOFA评分、尿素氮、血小板水平及血管活性药物需求等方面。临床医师应重视此类差异，实施个体化评估和治疗。

Abstract: Objective: To investigate the differences in clinical characteristics between critically ill patients with urosepsis who have negative versus positive blood cultures, and to provide evidence for clinical diagnosis and treatment based on blood culture results. Methods: A retrospective analysis was conducted on 62 patients with urosepsis admitted to the Second Department of Critical Care Medicine of our hospital between January 2021 and December 2024. According to blood culture results, patients were divided into negative and positive blood culture groups. The baseline data, infection indicators, organ function, interventions, and clinical outcomes were compared between the two groups. Results: There was no statistically significant difference in underlying comorbidities between the two groups (P > 0.05). Compared with the negative blood culture group, patients in the positive blood culture group had a significantly higher heart rate, higher Sequential Organ Failure Assessment (SOFA) scores and blood urea nitrogen levels, and lower platelet levels (all P < 0.05). Furthermore, the rate of combined vasoactive drug use, norepinephrine equivalent dosage, and maximum norepinephrine dose were significantly higher in the positive blood culture group than in the negative group (all P < 0.05). Conclusion: Differences in blood culture results among patients with urosepsis are associated with distinct clinical characteristics, primarily reflected in heart rate, SOFA score, urea nitrogen, platelet levels, and the requirement for vasoactive drugs. Clinicians should pay attention to these differences and implement individualized assessment and treatment.