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| 细菌培养状态对脓毒症患者临床结局的预测价值 |
| The predictive value of bacterial culture status for clinical outcomes in patients with sepsis |
| 投稿时间：2026-01-19 |
| DOI：10.3969/j.issn.1000-0399.2026.08.010 |
| 中文关键词: 细菌培养阴性 细菌培养阳性 脓毒症 脓毒性休克 |
| 英文关键词: Bacteria culture-negative Bacteria culture-positive Sepsis Septic shock |
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| 中文摘要: |
| 目的 探讨符合脓毒症-3(Sepsis-3)标准的患者中细菌培养阴性对临床结局的影响，并重点分析其在脓毒性休克亚组中的意义。方法 采用多中心回顾性队列研究，纳入2020年1月至2024年3月安徽省7家医院3 612例成年脓毒症患者为研究对象。根据入院后首次培养结果分为细菌培养阳性脓毒症组（n=2 283）和细菌培养阴性脓毒症组（n=1 329）。采用倾向评分匹配（PSM）平衡混杂因素后，每组各1 329例；在脓毒性休克亚组中，经PSM后，细菌培养阳性组与阴性组各纳入864例患者。主要终点为住院全因死亡率，次要终点包括重症监护病房（ICU）死亡率、初始经验性抗生素治疗适宜率等。结果 整体匹配队列中，两组患者住院死亡率比较，差异无统计学意义（38.2%比36.3%, P=0.081）。在脓毒性休克亚组中，阴性组ICU死亡率（34.1%比28.8%, P=0.019）和住院死亡率（40.5%比30.6%, P<0.001）均高于阳性组，且初始抗生素治疗适宜率较低（69.2%比78.9%, P<0.001）。多因素logistic回归分析结果显示，在脓毒性休克患者中，细菌培养阴性是住院死亡的独立危险因素（OR=1.537, 95%CI:1.256～1.883, P<0.001）。结论 细菌培养阴性脓毒性休克患者住院死亡风险增加，可能与其初始经验性抗生素治疗适宜率较低有关，是需要特别关注的高危临床亚组。 |
| 英文摘要: |
| Objective To investigate the impact of bacteria culture-negative status on clinical outcomes in patients meeting the sepsis-3 criteria, with a focus on its significance in the septic shock subgroup. Methods A multicenter retrospective cohort study was conducted, enrolling 3 612 adult sepsis patients from seven hospitals in Anhui province between January 2020 and March 2024. Patients were divided into a bacteria culture-positive group(n=2 283) and a bacteria culture-negative group(n=1 329) based on microbiological results. After balancing confounding factors using propensity score matching(PSM), 1 329 patients were included in each group for the primary analysis; within the septic shock subgroup, 864 patients were included in each group after PSM. The primary endpoint was in-hospital all-cause mortality, and secondary endpoints included ICU mortality, appropriateness of initial empirical antibiotic therapy, among others. Results In the overall matched cohort, no significant difference was observed in in-hospital mortality between the two groups(38.2% vs. 36.3%, P=0.081). However, in the septic shock subgroup, the culture-negative group had significantly higher ICU mortality(34.1% vs. 28.8%, P=0.019) and in-hospital mortality(40.5% vs. 30.6%, P<0.001) than the positive group, along with a lower rate of appropriate initial antibiotic therapy(69.2% vs. 78.9%, P<0.001). Multivariate logistic regression analysis revealed that bacteria culture-negative status was an independent risk factor for in-hospital death in septic shock patients(OR=1.537, 95% CI: 1.2561.883, P<0.001). Conclusion Bacteria culture-negative septic shock patients have an increased risk of in-hospital mortality, which may be associated with a lower rate of appropriate initial empirical antibiotic therapy. This subgroup represents a high-risk clinical entity requiring special attention. |
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