该研究旨在描述患有血流感染 (BSI) 的实体癌 (SC) 患者中多重耐药 (MDR) 细菌的流行病学，评估 25 年期间不适当的经验性抗生素治疗 (IEAT) 使用和死亡率趋势。对大学医院成年 SC 患者的所有 BSI 发生情况进行了五个不同的五年间隔的分析。 MDR细菌被分类为产生超广谱β-内酰胺酶（ESBL）和/或耐碳青霉烯类肠杆菌、对至少三种抗生素类耐药的非发酵革兰氏阴性杆菌（GNB）、耐甲氧西林金黄色葡萄球菌（MRSA）和耐万古霉素肠球菌。多元回归模型确定了 MDR BSI 的风险因素。在 6,117 起 BSI 事件中，革兰氏阴性杆菌 (GNB) 占 60.4% (3,695/6,117)，最常见的是大肠杆菌，占 26.8% (1,637/6,117)、克雷伯氏菌。 12.4% (760/6,117)，铜绿假单胞菌 8.6% (525/6,117)。 MDR-GNB 占 644 次（MDR 的 84.8% 或 644/759），主要是产 ESBL 菌株（71.1% 或 540/759），并且随着时间的推移显着升级。 IEAT 在 24.8% 的发作中使用，主要是在 MDR BSI 中，并且与较高的死亡率相关（22.9% vs. 14%，P < 0.001）。 MDR BSI 的独立因素是既往使用抗生素[比值比 (OR) 2.93，置信区间 (CI) 2.34-3.67]、抗生素治疗期间的 BSI（OR 1.46，CI 1.18-1.81）、胆汁（OR 1.84，CI 1.34-2.52） ）或尿源（OR 1.86，CI 1.43-2.43），入院时间（OR）1.28，CI 1.18-1.38，以及社区获得性感染（OR 0.57，CI 0.39-0.82）。研究表明，患有 BSI 的 SC 患者中 MDR-GNB 有所增加。四分之一的人接受了 IEAT，这与死亡率增加有关。改善 MDR 感染的风险评估和明智地处方经验性抗生素对于获得更好的结果至关重要。多重耐药 (MDR) 细菌对全球公共卫生构成威胁，因为它们治疗起来更具挑战性，而且数量还在增加。实体癌症患者通常因其疾病和癌症治疗而免疫功能低下，使他们更容易受到感染。了解实体瘤患者血流感染的变化和趋势至关重要，有助于医生就适当的抗生素治疗做出明智的决定，管理这一弱势群体的感染并预防感染。实体癌患者通常需要密集且长期的治疗，包括手术、化疗和放射治疗。感染会使这些治疗变得复杂，导致治疗延误、医疗费用增加和患者预后较差。研究对抗耐多药感染的新策略并研究针对这些患者的新型抗生素对于避免这些负面影响至关重要。

The study aimed to describe the epidemiology of multidrug-resistant (MDR) bacteria among solid cancer (SC) patients with bloodstream infections (BSIs), evaluating inappropriate empiric antibiotic treatment (IEAT) use and mortality trends over a 25-year period. All BSI occurrences in adult SC patients at a university hospital were analyzed across five distinct five-year intervals. MDR bacteria were classified as extended-spectrum beta-lactamases (ESBL)-producing and/or Carbapenem-resistant Enterobacterales, non-fermenting Gram-negative bacilli (GNB) resistant to at least three antibiotic classes, methicillin-resistant Staphylococcus aureus (MRSA), and Vancomycin-resistant Enterococci. A multivariate regression model identified the risk factors for MDR BSI. Of 6,117 BSI episodes, Gram-negative bacilli (GNB) constituted 60.4% (3,695/6,117), being the most common are Escherichia coli with 26.8% (1,637/6,117), Klebsiella spp. with 12.4% (760/6,117), and Pseudomonas aeruginosa with 8.6% (525/6,117). MDR-GNB accounted for 644 episodes (84.8% of MDR or 644/759), predominantly ESBL-producing strains (71.1% or 540/759), which escalated significantly over time. IEAT was administered in 24.8% of episodes, mainly in MDR BSI, and was associated with higher mortality (22.9% vs. 14%, P < 0.001). Independent factors for MDR BSI were prior antibiotic use [odds ratio (OR) 2.93, confidence interval (CI) 2.34-3.67], BSI during antibiotic treatment (OR 1.46, CI 1.18-1.81), biliary (OR 1.84, CI 1.34-2.52) or urinary source (OR 1.86, CI 1.43-2.43), admission period (OR) 1.28, CI 1.18-1.38, and community-acquired infection (OR 0.57, CI 0.39-0.82). The study showed an increase in MDR-GNB among SC patients with BSI. A quarter received IEAT, which was linked to increased mortality. Improving risk assessment for MDR infections and the judicious prescription of empiric antibiotics are crucial for better outcomes.Multidrug-resistant (MDR) bacteria pose a global public health threat as they are more challenging to treat, and they are on the rise. Solid cancer patients are often immunocompromised due to their disease and cancer treatments, making them more susceptible to infections. Understanding the changes and trends in bloodstream infections in solid cancer patients is crucial, to help physicians make informed decisions about appropriate antibiotic therapies, manage infections in this vulnerable population, and prevent infection. Solid cancer patients often require intensive and prolonged treatments, including surgery, chemotherapy, and radiation therapy. Infections can complicate these treatments, leading to treatment delays, increased healthcare costs, and poorer patient outcomes. Investigating new strategies to combat MDR infections and researching novel antibiotics in these patients is of paramount importance to avoid these negative impacts.