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目的 探讨近年来血流感染的病原菌分布及其对抗菌药物的耐药状况.方法 选择2004年1月-2008年11月在我院住院的575例血流感染患者,对患者的细菌鉴定及药敏试验结果进行回顾性分析.结果 从575例血流感染患者中共分离出645株病原菌,其中革兰阴性菌338株(占52.4%)、革兰阳性菌267株(占41.4%)、真菌40株(占6.2%),52例患者发生混合感染.分离的病原菌中,主要为凝固酶阴性葡萄球菌(27.6%)、大肠埃希菌(21.7%)、肺炎克雷伯菌(12.6%)、葡萄糖非发酵菌(9.9%)、肠球菌属(3.9%).产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌、肺炎克雷伯菌检出率分别为46.4%和19.7%;耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为54.8%和89.3%.在葡萄糖非发酵菌中,鲍曼不动杆菌、铜绿假单胞菌和洋葱伯克霍尔德菌对多数抗菌药物的耐药率较高;未发现对万古霉素耐药的革兰阳性球菌.结论 导致血流感染的病原菌以革兰阴性菌为主,且血流感染的病原菌的多重耐药增加,尤其是葡萄糖非发酵菌.开展病原菌耐药性监测,对指导临床合理使用抗菌药物及减少耐药菌的产生有重要意义.“,”Objective To study the distribution and drug resistance of pathogenic bacteria in patients with bloodstream infection(BSI).Methods Five hundred and seventy-five BSI patients hospitalized from Jan.2004 to Nov.2008 were enrolled to perform a retrospective analysis on bacterial identification and drug sensitive test results.Results A total of 645 strains of pathogenic bacteria were isolated,including 338 gram-negative (52.4%),267 gram-positive(41.4%),40 fungi(6.2%).Mixed infection was found in 52 patients.The isolated pathogenic bacteria were mainly coagulase-negative staphylococci(27.6%),Escherichia coli(21.7%),klebsiella pneumoniae(12.6%),glucose non-fermentative bacteria(9.9%),enterococcus(3.9%).The detection rates of Escherichia coli and klebsiella pneumoniae producing superspectrum β-lactamases (ESBLs)were 46.4%,19.7%,respectively;those of methicillin resistant S.aureus(MRSA) and meticillin-resistant coagulase-negative staphylococci(MRCNS) were 54.8%,89.3%,respectively.Glucose non-fermentative bacteria,acinetobacter baumannii,pseudomonas aeruginosa and burkholderia cepacia were highly resistant to most antimicrobials;gram-positive cocci resistant to vancomycin were not found.Conclusion The pathogenic bacteria inducing BSI are mainly gram-negative,and the multiple drug resistance of BSI pathogenic bacteria,especially glucose non-fermentative,is increasing.Monitoring drug resistance of pathogenic bacteria is of importance in guiding clinical rational use of antimicrobial drugs and reducing drug resistance bacteria.