目的：分析社区获得性血流感染（Community-acquired Bloodstream Infection，CABSI）的病原菌分布、耐药情况及预后危险因素，为临床医师诊断及治疗提供依据。方法：收集2017年1月至2019年12月CABSI患者分离的病原菌及临床资料，并按治疗28d转归分为死亡组和存活组。用χ2检验进行单因素分析，与死亡相关的变量采用Logistic二元回归进行多因素分析。 结果：292例CABSI患者分离病原菌323株，其中革兰阴性菌192株，革兰阳性菌118株，真菌9株和厌氧菌4株。革兰阴性菌对头霉素类、碳青霉烯类和氨基糖苷类抗菌药物耐药率均在10%以下，金黄色葡萄球菌对庆大霉素和莫西沙星的耐药率小于20%，链球菌属对青霉素类耐药率为6.7%。292例患者中55例死亡，死亡率为18.8%。单因素分析显示脑梗塞、感染性休克、肺炎克雷伯菌感染、α溶血链球菌感染、降钙素原（Procalcitonin，PCT）升高与患者死亡有关。脑梗塞、感染性休克和PCT水平升高是CABSI患者预后相关的独立危险因素（P<0.05）。 结论：CABSI患者病原菌对临床常用抗菌药物耐药率较低。脑梗塞、感染性休克和PCT升高能显著增加患者死亡率，临床医师应及时采取相应防治措施。
Objective We investigate the distribution of pathogens, drug resistance and prognostic risk factors in patients with community-acquired bloodstream infection, so as to provide etiological evidence for managing bloodstream infection. Methods Pathogens and clinical data were collected from CABSI patients from January 2017 to December 2019, and the patients were divided into death group and survival group according to the prognosis. Univariate and multivariate analysis were carried out to identify the potential predictors of mortality. Results 323 pathogens were isolated, including 192 Gram-negative strains, 118 Gram-positive strains, 9 fungal strains and 4 anaerobic strains. For Gram-negative strains, the drug resistance rates of cephamycins, carbapenem, and aminoglycosides were all lower than 10%. The resistance rates of Staphylococcus aureus to gentamicin and moxifloxacin were lower than 20%. The resistance rate of Streptococcus app. to penicillins was 6.7%. The overall mortality rate of CABSI was 18.8%. Univariate analysis showed that cerebral infarction, septic shock, Klebsiella pneumoniae infection, α hemolytic streptococcus infection and PCT value were associated with mortality (P<0.05). Cerebral infarction and septic shock are independent risk factors associated with prognosis in CABSI patients (P<0.05). Conclusion Pathogens of CABSI patients had low resistance to clinical antimicrobial agents. Cerebral infarction, septic shock and high PCT values can significantly increase the mortality, so clinicians should take corresponding measures as early as possible to reduce the mortality.