目的：通过对血流感染中病原菌病区来源,各年度多重耐药细菌的检出趋势进行分析,指导临床科学用药。方法：对2011年1月至2018年12月血标本中分离出的2751株病原菌进行标本来源和多重耐药细菌的检出趋势分析；数据分析采用Whonet 5.6统计软件,差异显著性分析使用SPSS 20软件,耐药率比较采用X_²检验。结果：2011-2018年从血标本中检出的病原菌占所有病原菌的比例为9.0%,其中2013-2018年检出率呈递减趋势(P＜0.05)；构成比最多的细菌为大肠埃希菌(28.4%)、人葡萄球菌(14.3%)、表皮葡萄球菌(12.2%)、肺炎克雷伯菌(10.3%)和屎肠球菌(4.7%)。G_^-杆菌的比例(52.1%)高于G_⁺球菌的比例(43.9%)。2011-2018年血流感染中MRSA、CR-AB和CR-KP多重耐药菌的检出率分别为42.8%(77/180)、73.8%(45/61)和9.9%(28/284)；其中从ICU检出占比均最多,分别为45.5%(35/77)、82.2%(37/45)和57.1%(16/28)；2011-2014年间MRSA的检出率有增长趋势,但差异无显著性(P＞0.05)；2014-2018年呈降低趋势,差异有显著性(P＜0.05)。2011-2016年CR-KP均未检出,而2017年和2018年检出高达10.5%和30.4%。结论：血流感染严重,血培养检验重要,加强多重耐药细菌的管理；实验室应定期对本地区血流感染病原菌进行监测,临床应根据监测结果,合理选择抗菌药物,降低血流感染的病死率。

Abstract: Objective: To analyze the trend of detection of multi-drug resistant bacteria in blood stream infection and guide the clinical use of drugs.Methods: 2,751 strains of pathogenic bacteria isolated from blood samples from January 2011 to December 2018 were analyzed for specimen origin and detection trend of multi-drug resistant bacteria.Whonet 5.6 statistical software was used for data analysis, SPSS 20 software was used for difference significance analysis, and X2 test was used for drug resistance rate comparison.Results: The proportion of pathogenic bacteria detected in blood samples from 2011 to 2018 was 9.0%, and the detection rate showed a decreasing trend from 2013 to 2018 (P < 0.05).The bacteria with the largest composition ratio were Escherichia coli (28.4%), Staphylococcus aureus (14.3%), Staphylococcus epidermidis (12.2%), Klebsiella pneumoniae (10.3%) and Enterococcus faecalis (4.7%).The proportion of G- bacilli (52.1%) was higher than that of G+ cocci (43.9%).The detection rates of MRSA, CR-AB and CR-KP in bloodstream infections from 2011 to 2018 were 42.8% (77/180), 73.8% (45/61) and 9.9% (28/284), respectively.The ICU detection rate was 45.5% (35/77), 82.2% (37/45) and 57.1% (16/28), respectively.The detection rate of MRSA increased from 2011 to 2014, but the difference was not significant (P > 0.05).From 2014 to 2018, it showed a decreasing trend, with a significant difference (P < 0.05).Cr-kp was not detected from 2011 to 2016, but detected as high as 10.5% and 30.4% in 2017 and 2018.Conclusion: Blood flow infection is serious, blood culture examination is important, strengthen the management of multi-drug resistant bacteria;The laboratory should monitor the pathogen of blood flow infection in this area regularly, and the clinical medicine should be selected reasonably according to the monitoring results to reduce the mortality of blood flow infection.

内蒙古自治区卫生计生科研计划项目(201702004)