【摘要】 目的：了解本院重症加强护理病房（ICU）血流感染患者的致病菌分布情况及其耐药特征。方法：回顾性分析本院2019年1月～2020年12月期间ICU患者送检的血培养标本中分离到的致病菌的药敏试验结果及耐药表型检测结果，使用WHONET 5.6软件对结果进行分析。结果：107例ICU血流感染患者的血培养标本中共分离出111株致病菌，其中革兰阴性菌63株（56.8%）、革兰阳性菌40株（36.0%）、真菌8株（7.2%）。排在前6位的细菌分别为肺炎克雷伯菌（26株，23.4%）、大肠埃希菌（22株，19.8%）、表皮葡萄球菌（11株，9.9%）、屎肠球菌（9株，8.1%）、金黄色葡萄球菌（7株，6.3%）、鲍曼不动杆菌（5株，4.5%）。血流感染患者的感染部位以肺部和腹腔居多，分别占18.9%和16.2%。凝固酶阴性葡萄球菌和金黄色葡萄球菌中甲氧西林耐药率分别为81.8%和57.1%，未发现耐利奈唑胺和万古霉素的菌株。肺炎克雷伯菌、大肠埃希菌中产超广谱β-内酰胺酶（ESBL）的菌株分别占53.8%和36.3%。肺炎克雷伯菌和鲍曼不动杆菌对碳青霉烯类抗生素的耐药率分别为42.3%和80.0%。大肠埃希菌对碳青霉烯类抗生素仍有很高的敏感性，耐药率仅为4.5%。结论：ICU血流感染患者感染的致病菌以革兰阴性菌为主，肺炎克雷伯菌和鲍曼不动杆菌对碳青霉烯类抗生素的耐药率很高，ICU应加强感控措施，及时确定血流感染致病菌及其耐药性，根据药敏结果选择合适的抗生素，优化抗生素的临床用药方案，减少耐药菌产生。更多还原

【Abstract】 Objective: To understand the distribution and drug resistance characteristics of pathogenic bacteria in patients with bloodstream infection in intensive care unit(ICU) of our hospital. Methods: The drug sensitivity results and drug resistance phenotype results of pathogenic bacteria isolated from blood culture of ICU patients admitted to our hospital from January 2019 to December 2020 were retrospectively analyzed,and the results were analyzed using WHONET5.6 software. Results: A total of 111 strains of pathogenic bacteria were isolated from blood culture specimen of 107 patients with bloodstream infection. Of these,63(56.8%) were gram negative bacteria, 40(36.0%) were gram positive bacteria, and 8(7.2%) were fungi.The top 6 bacteria were Klebsiella pneumoniae(26 strains, 23.4%), Escherichia coli(22 strains, 19.8%),Staphylococcus epidermidis(11 strains, 9.9%), Enterococcus faecium(9 strains, 8.1%), Staphylococcus aureus(7 strains, 6.3%), and Acinetobacter baumannii(5 strains, 4.5%). The main infection sites of patients with blood flow infection were lung and abdominal cavity, accounting for 18.9% and 16.2% respectively.The methicillin resistance rates of coagulase-negative Staphylococci and Staphylococcus aureus were 81.8%and 57.1%, respectively, and no strains resistant to linezolid and vancomycin were found. The strains of Klebsiella pneumoniae and Escherichia coli producing extended spectrum β-lactamase(ESBL) accounted for 53.8% and 36.3%, respectively. The resistance rates of Klebsiella pneumoniae and Acinetobacter baumannii to carbapenems were 42.3% and 80.0%, respectively. Escherichia coli still showed high sensitivity to carbapenems, and the resistance rate was only 4.5%. Conclusions: The majority of blood influenza infected pathogenic bacteria in ICU are gram negative bacteria, Klebsiella pneumoniae and Acinetobacter baumannii have a high rate of resistance to carbapenems. Measures of sensory control should be strengthened in ICU, as well as timely identification of blood influenza infected pathogenic bacteria and their resistance. Antibiotics should be chosen appropriately according to drug sensitivity results and clinical medication scheme of antibiotics should be optimized, in order to reduce the production of drug-resistent bacteria.更多还原