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目的:监测2020—2021年我国引起院内感染的主要病原菌的病原谱分布和对主要抗菌药物的敏感性。方法:回顾性收集来自我国10家教学manbet官网登录 的引起院内血流感染（BSI，670株）、manbet官网登录 获得性肺炎（HAP，394株）和院内腹腔感染（IAI，247株）的病原菌1 311株。经中心实验室复核菌株后，对临床常见菌株进行抗菌药物药敏试验，采用琼脂稀释法或微量肉汤稀释法测定菌株的最低抑菌浓度（MIC），药敏折点采用美国临床和实验室标准协会2023年M100（第33版）标准。使用χ 2检验进行率的比较。 结果:BSI最主要的致病菌是大肠埃希菌（21.2%，142/670）、肺炎克雷伯菌（14.9%，100/670）和金黄色葡萄球菌（11.5%，77/670）；HAP最主要致病菌是肺炎克雷伯菌（27.7%，109/394）、鲍曼不动杆菌（22.1%，87/394）和铜绿假单胞菌（18.3%，72/394）；IAI最主要的致病菌是大肠埃希菌（24.3%，60/247）、屎肠球菌和肺炎克雷伯菌（均为14.6%，36/247）。金黄色葡萄球菌对替加环素、利奈唑胺、达托霉素和糖肽类抗菌药物均表现为敏感。甲氧西林耐药的金黄色葡萄球菌（MRSA）和凝固酶阴性葡萄球菌（MRCNS）的检出率分别为36.5%（42/115）和74.5%（38/51）。屎肠球菌和粪肠球菌对万古霉素的耐药率分别为3.3%（3/90）和1.9%（1/53）。肺炎克雷伯菌和大肠埃希菌中超广谱β内酰胺酶的检出率分别为23.7%（58/245）和60.5%（130/215），碳青霉烯耐药株的检出率分别为29.8%（73/245）和4.2%（9/215），对替加环素的耐药率分别为1.6%（4/245）和0，对黏菌素的耐药率分别为1.6%（4/245）和2.8%（6/215），对头孢他啶/阿维巴坦的耐药率分别为2.0%（5/245）和2.3%（5/215）。鲍曼不动杆菌除对黏菌素（98.8%，161/163）和替加环素（89.6%，146/163）表现出较高的敏感性，对其他抗菌药物均表现出较高的耐药率，碳青霉烯耐药株的检出率达到76.7%（125/163）。碳青霉烯耐药的铜绿假单胞菌检出率为28.4%（33/116）；黏菌素、阿米卡星和头孢他啶/阿维巴坦对铜绿假单胞菌表现出较强的抗菌活性，敏感率分别为99.1%（115/116）、94.0%（109/116）和83.6%（97/116）。结论:引起院内感染的主要病原菌是肺炎克雷伯菌、大肠埃希菌、鲍曼不动杆菌、铜绿假单胞菌和金黄色葡萄球菌。替加环素、黏菌素和头孢他啶/阿维巴坦对大部分常见革兰阴性杆菌表现出较强的抗菌活性。鲍曼不动杆菌耐药问题依然严重。碳青霉烯耐药的肠杆菌目细菌检出率继续升高，需继续加强抗菌药物合理应用及manbet官网登录 感染防控。

Objective:To investigate the spectrum and antimicrobial resistance of major pathogens causing nosocomial infections in China during 2020-2021.Methods:A total of 1 311 non-duplicated nosocomial pathogens causing bloodstream infections (BSI, n=670), hospital-acquired pneumonia (HAP, n=394) and intra-abdominal infections (IAI, n=297) were collected from 10 teaching hospitals across China. The minimum inhibitory concentrations (MICs) of clinical common strains were determined using agar dilution or broth microdilution method. Interpretation of reults followed the CLSI M100-Ed33 criteria, with data analysis conducted using WHONET-5.6 software. The Chi-square test was used to compare rates. Results:The most prevalent pathogens causing BSI were Escherichia coli (21.2%, 142/670), Klebsiella pneumoniae (14.9%, 100/670) and Staphylococcus aureus (11.5%, 77/670); the most prevalent pathogens causing HAP were K. pneumoniae (27.7%, 109/394), Acinetobacter baumanii (22.1%, 87/394) and Pseudomonas aeruginosa (18.3%, 72/394). IN IAI, E. coli (24.3%, 60/247), Enterococcus faecium and K. pneumoniae (both 14.6%, 36/247) were dominated. All S. aureus strains were susceptible to tigecycline, linezolid, daptomycin and glycopeptides. Rates of methicillin-resistant S. aureus (MRSA) and coagulase-negative Staphylococcus (MRCNS) were 36.5% (42/115) and 74.5% (38/51), respectively. The rate of vancomycin-resistant E. faecium and E. faecalis was 3.3% (3/90) and 1.9% (1/53), respectively. The prevalence of extended-spectrum β-lactamase (ESBL) was 23.7% (58/245) in K. pneumonia and 60.5% (130/215) in E. coli.The rate of carbapenem-resistant K. pneumonia and E. coli was 29.8% (73/245) and 4.2% (9/215), respectively; the percentage of tigecycline-resistant K. pneumonia and E. coli was 1.6% (4/245) and 0, respectively; the rate of colistin-resistant K. pneumonia and E. coli was 1.6% (4/245) and 2.8% (6/215), respectively; the percentage of ceftazidime/avibactam-resistant K. pneumonia and E. coli was 2.0% (5/245) and 2.3% (5/215), respectively. The rate of carbapenem-resistant A. baumanii and P. aeruginosa was 76.7% (125/163) and 28.4% (33/116), respectively. A. baumanii showed low susceptibility to most antimicrobial agents except colistin (98.8%, 161/163) and tigecycline (89.6%, 146/163). Colistin, amikacin and ceftazidime/avibactam demonstrated high antibacterial activity against P. aeruginosa with susceptility rates of 99.1% (115/116), 94.0% (109/116) and 83.6% (97/116), respectively. Conclusions:The major pathogens of nosocomial infections were K. pneumonia, E. coli, A. baumanii, P. aeruginosa and S. aureus. Nosocomial Gram-negative pathogens exhibited high susceptibilities to tigecycline, colistin and ceftazidime/avibactam. Antimicrobial resistance in A. baumannii remains a significant challenge. The increasing prevalence of carbapenem-resistant Enterobacterales underscores the urgency of antibiotics rational applications and hospital infection controls.