目的 分析天津市胸科医院血流感染多重耐药菌的菌株流行情况和危险因素，为其合理治疗及控制提供循证学依据。方法 收集2015年1月1日—2019年12月31日天津市胸科医院全血标本分离出的菌株，分析各类多重耐药菌株变迁趋势、耐药性，以及医院获得性血流感染的危险因素。结果 5年间全血标本共分离菌株1 207株，检出多重耐药菌134株，检出率11.10%。多重耐药菌株总体数量以及产超广谱β内酰胺酶（ESBLs）肠杆菌、耐碳青霉烯类鲍曼不动菌（CRAB）变化趋势均不大。产ESBLs细菌对头孢菌素类、喹诺酮类、复方新诺明等耐药严重，CRAB对除替加环素、米诺环素、粘菌素外的抗菌药物耐药率均较高。与对照组相比，糖尿病（OR=2.202，P=0.005）、低蛋白血症（OR=9.502，P=0.006）、机械通气（OR=0.051，P=0.002）、行外科手术（OR=8.056，P=0.012）、入住ICU（OR=5.200，P=0.035）是观察组患者发生多重耐药菌感染的独立危险因素。结论 临床医生应严格遵照抗菌药物分级管理制度，合理应用抗菌药，同时，密切关注菌株流行情况，重视感染的早期防控，积极预防和控制多重耐药菌的产生和流行。

Objective To analyze the clinical distribution and prevalence of multi-drug resistant bacterial bloodstream infection in Tianjin Chest Hospital, and to provide evidence-based basis for reasonable treatment and infection control. Methods Collecting multi-drug resistant bacteria strains which isolated from whole blood samples of Tianjin Chest Hospital, during January 1, 2015 to December 31, 2019, analyzing the change trend, drug resistance and risk factors in hospital infection in bloodstream. Results A total of 1 207 strains were isolated from whole blood samples in 5 years, and 134 strains of multi-drug resistant bacteria were detected, with a detection rate of 11.10%. The overall number of multi-drug resistant strains, ESBLs and CRAB showed little trend. ESLBs-producing bacteria had serious resistance to several antibacterial drugs such as cephalosporins, quinolones and compounding. CRAB had a high resistance rate to antibiotics except for tigecycline, minocycline and colistin. Diabetes (OR=2.202, P=0.005), hypoproteinemia (OR=9.502, P=0.006), mechanical ventilation (OR=0.051, P=0.002), surgery (OR=8.056, P=0.012) and admission to ICU (OR=5.200, P=0.035) were independent risk factors for multi-drug resistant bacteria infection. Conclusions Effective measures should be taken to strengthen the rational application of antimicrobial agents. In the meantime, the prevalence of bacterial strains should be paid close attention, so that we can actively prevent and control the emergence and epidemic of multi-drug resistant strains.

R978.1

天津市科学技术成果进步奖（津20171008）