糖尿病足溃疡处常见病原菌分布与耐药性分析

Common Pathogens in Diabetic Foot Ulcer: Their Distribution and Antibiotic Resistance

目的探讨广州地区糖尿病足溃疡处常见病原菌分布及耐药情况. 方法回顾性分析1999～2003年从糖尿病足溃疡处分泌物中分离的 405株病原菌及其耐药情况. 结果 1999～2003年糖尿病足溃疡感染呈逐年上升的趋势;病原菌以革兰阳性菌为主(57.8%),其次是革兰阴性菌(37.8%)和真菌(4.3%);真菌感染呈上升的趋势,以白色念珠菌为主;革兰阳性菌的菌群分布为金黄色葡萄球菌21.0%、表皮葡萄球菌23.0%、肠球菌属13.8%,未见对万古霉素耐药的革兰阳性菌;革兰阴性菌的菌群分布为大肠埃希菌15.1%、变形菌属10.9%、铜绿假单胞菌8.9%、其他肠杆菌属为3.0%;亚胺培南、头孢吡肟对革兰阴性菌抗菌活性较高;其他常用抗菌药物有不同程度的耐药,大肠埃希菌产超广谱β-内酰胺酶(ESBLs)的发生率是50.2%. 结论糖尿病足溃疡感染的病原菌以革兰阳性菌为主;万古霉素及亚胺培南仍保持较高抗菌活性,不间断地对糖尿病足感染的病原菌及其耐药性进行监测,可为糖尿病足溃疡感染防治提供依据.

OBJECTIVE To investigate the distribution and resistance rates of pathogens isolated from diabetic foot ulcer. METHODS A retrospective study was carried out on the distribution and resistance rates in 405 strains of pathogens isolated from diabetic foot ulcer patients from 1999 to 2003. RESULTS The infections in diabetic foot ulcer were increasing during 1999-2003. Among 405 strains, 57. 8％ were Gram-positive bacteria, 37.8％ were Gram-negative bacteria, and 4.3％ were candida infection. Candida albicans was the common pathogen. Other pathogens included Staphylococcus aureus （21.0％）, S. epidermidis （23.0％）, Enterococcus spp. （13.8％）,Escherichia coil （ 15. 1％）, Proteus spp. （ 10. 9 ％）, Pseudomonas aeruginosa （ 8.9 ％）, and Enterobacter spp.（3.0％）. Imipenem and cefepime were highly active against Enterobacteriaceae. Vancomycin resistant staphylococci were not found, 50.2％ strains of E. coli were producing extended-spectrum beta-lactamases （ESBLs）. CONCLUSIONS The most common pathogens causing nosocomial infection are Gram-positive bacteria.Imipenem and vancomycin are highly active against bacteria. It is important to survey pathogens and their antibiotic resistance in diabetic foot ulcer infection.