目的 分析天津市胸科醫(yī)院血流感染多重耐藥菌的菌株流行情況和危險(xiǎn)因素，為其合理治療及控制提供循證學(xué)依據(jù)。方法 收集2015年1月1日—2019年12月31日天津市胸科醫(yī)院全血標(biāo)本分離出的菌株，分析各類多重耐藥菌株變遷趨勢(shì)、耐藥性，以及醫(yī)院獲得性血流感染的危險(xiǎn)因素。結(jié)果 5年間全血標(biāo)本共分離菌株1 207株，檢出多重耐藥菌134株，檢出率11.10%。多重耐藥菌株總體數(shù)量以及產(chǎn)超廣譜β內(nèi)酰胺酶（ESBLs）腸桿菌、耐碳青霉烯類鮑曼不動(dòng)菌（CRAB）變化趨勢(shì)均不大。產(chǎn)ESBLs細(xì)菌對(duì)頭孢菌素類、喹諾酮類、復(fù)方新諾明等耐藥嚴(yán)重，CRAB對(duì)除替加環(huán)素、米諾環(huán)素、粘菌素外的抗菌藥物耐藥率均較高。與對(duì)照組相比，糖尿?。∣R=2.202，P=0.005）、低蛋白血癥（OR=9.502，P=0.006）、機(jī)械通氣（OR=0.051，P=0.002）、行外科手術(shù)（OR=8.056，P=0.012）、入住ICU（OR=5.200，P=0.035）是觀察組患者發(fā)生多重耐藥菌感染的獨(dú)立危險(xiǎn)因素。結(jié)論 臨床醫(yī)生應(yīng)嚴(yán)格遵照抗菌藥物分級(jí)管理制度，合理應(yīng)用抗菌藥，同時(shí)，密切關(guān)注菌株流行情況，重視感染的早期防控，積極預(yù)防和控制多重耐藥菌的產(chǎn)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

天津市科學(xué)技術(shù)成果進(jìn)步獎(jiǎng)（津20171008）