【摘要】 目的 了解某院主要耐碳青霉烯类革兰阴性杆菌（CR-GNB）的临床分布及耐药性，分析感染特征及危险因素，为临床干预治疗提供理论依据。方法 2017年1月至2020年1月在某院收集CR-GNB，应用珠海迪尔DL-96Ⅱ全自动细菌分析仪进行鉴定和药敏试验。采用单因素分析及多因素Logistic回归分析探讨医院CR-GNB感染的危险因素。结果 共检出CR-GNB505株，以非发酵菌数量最多（275株，54.45%），主要分布在ICU(231株，45.74%)。标本种类以痰液为主（278株，55.05%）。细菌对常见药物耐药率> 80.00%且表现为多重耐药，鲍曼不动杆菌对多粘菌素B耐药率最低；铜绿假单胞菌对多粘菌素B和阿米卡星较敏感；肺炎克雷伯杆菌对阿米卡星、复方新诺明耐药率较低；大肠埃希菌对呋喃妥因敏感率较高；黏质沙雷菌对阿米卡星和复方新诺明耐药率<10.00%。住院时间>14 d、入住ICU、手术治疗、脑血管病、肿瘤、气管插管、留置胃管是CR-GNB感染的独立危险因素。结论CR-GNB以非发酵菌为主，且多重耐药情况严重，可选择药物种类有限。感染具有多个独立危险因素，临床医生需制定合理抗感染治疗方案，以减少CR-GNB的产生。更多还原

【Abstract】 Objective To understand the clinical distribution and drug resistance of major carbapenems gram-negative bacilli(CR-GNB) in a hospital, analyze infection characteristics and risk factors, and provide theoretical basis for clinical intervention treatment. Methods We collected CR-GNB clinically separated from a hospital from January 2017 to January 2020, and used Zhuhai DL-96Ⅱ,an automatic bacteria analyzer, for identification and drug susceptibility testing. Univariate analysis and multivariate Logistic regression analysis were used to investigate the risk factors of hospital CR-GNB infection. Results A total of 505 CR-GNB strains were detected, of which the number of non-fermentative bacteria was the largest(275 strains,54.45%), mainly distributed in ICU(231 strains, 45.74%).Sputum was the main sample(278 strains, 55.05%). The bacteria showed multi-drug resistance rate of > 80.00%to common drugs, and acinetobacter baumannii had the lowest resistance rate to polymyxin B; Pseudomonas aeruginosa was more sensitive to polymyxin B and amikacin; Klebsiella pneumoniae had a lower resistance rate to amikacin and co-trimoxazole; Escherichia coli was more sensitive to nitrofurantoin; The resistance rate of Serratia marcescens to amikacin and co-trimoxazole was <10.00%. Length of hospitalization over 14 days,admission to ICU, hypoproteinemia, surgical treatment,cerebrovascular disease, tumor, tracheal intubation, and indwelling gastric tube are independent risk factors for CR-GNB infection. Conclusion Among the CR-GNB,non-fermentative bacteria were dominant, and their multi drug resistance was serious, so the range of drugs available was limited. Since infections have multiple independent risk factors, clinicians should formulate a reasonable anti-infection treatment plan to reduce the production of CR-GNB.更多还原