摘要 目的 了解碳青霉烯耐药革兰阴性菌（CR-GNB）血流感染的发生率、病原菌的种类及分布情况；分析疾病危险因素对患者预后的影响，为早期诊断及干预提供依据。 方法 对2016年1月—2017年12月入住我院的11 231例患者中发生革兰阴性菌血流感染情况进行调查，其中将发生CR-GNB血流感染的住院患者作为CR-GNB组，将发生碳青霉烯敏感革兰阴性菌(CS-GNB)血流感染的住院患者作为CS-GNB组。对两组血流感染的临床特征与危险因素进行分析。 结果 11 231例住院患者中发生革兰阴性菌血流感染者292例(2.60%)，CR-GNB血流感染者83例(0.74%)，CS-GNB血流感染者209例(1.86%)。单因素Logistic回归分析显示，循环系统疾病、肺部疾病、糖尿病、肝脏疾病、年龄≥65岁、ICU住院、复数菌性血流感染、二联抗菌药物应用、三联抗菌药物应用、碳青霉烯类药物应用、机械通气、中心静脉置管、留置导尿管、手术等为CR-GNB血流感染的可能危险因素。多因素Logistic回归分析显示，肝脏疾病、糖尿病、ICU住院、机械通气、三联抗菌药物应用等为CR-GNB血流感染的独立危险因素。 结论 在临床中应加强感控措施，特别是对CR-GNB血流感染的影响因素应采取针对性干预措施，以防止CR-GNB血流感染的发生。 Abstract：Objective To investigate the incidence of bloodstream infection with carbapenem-resistant Gram-negative bacteria (CR-GNB) as well as the types and distribution of pathogenic bacteria, analyze the effect of disease-related risk factors on patient outcomes, and to provide evidence for early diagnosis and intervention. Methods We investigated the incidence of bloodstream infection with Gram-negative bacteria in 11 231 patients admitted to our hospital from January 2016 to December 2017. Patients with bloodstream infection with CR-GNB were classified as CR-GNB group, and those with bloodstream infection with carbapenem-sensitive Gram-negative bacteria (CS-GNB) were classified as CS-GNB group. The clinical characteristics and risk factors for bloodstream infection were compared between the two groups. Results Bloodstream infection with Gram-negative bacteria occurred in 292 (2.60%) of the 11 231 patients. Eighty-three patients (0.74%) had bloodstream infection with CR-GNB, and 209 patients (1.86%) had bloodstream infection with CS-GNB. Univariate logistic regression analysis showed that possible risk factors for bloodstream infection with CR-GNB included circulatory system diseases, lung diseases, diabetes, liver diseases, age ≥65 years, ICU hospitalization, polymicrobial bloodstream infection, combined use of two antibiotics, combined use of three antibiotics, carbapenem use, mechanical ventilation, central venous catheterization, indwelling urinary catheterization, and surgical operation. Multivariate logistic regression analysis showed that liver diseases, diabetes, ICU hospitalization, mechanical ventilation, and combined use of three antibiotics were independent risk factors for bloodstream infection with CR-GNB. Conclusion Infection prevention and control measures should be strengthened in clinical practice, especially targeting risk factors for bloodstream infection with CR-GNB, to prevent and control bloodstream infection with CR-GNB
