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 DRUG RESISTANCE

目的探讨我院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2003-2005年从糖尿病足溃疡处分泌物中分离的129株病原菌及其耐药情况。结果2003-2005年糖尿病足溃疡感染呈上升的趋势;病原菌以革兰阴性菌为主（63.6%）,其次是革兰阳性球菌（31.8%）和真菌（5.4%）;真菌感染呈上升的趋势,以白色念珠菌为主;革兰阴性菌的菌群分布为大肠埃希菌24.8%、变形菌属10.9%、铜绿假单胞菌17.0%、嗜麦芽寡养单胞菌3.1%、其他肠杆菌属7.8%。亚胺培南、头孢哌酮-舒巴坦对革兰阴性菌抗菌活性较高,对其他常用抗菌药物有不同程度的耐药。革兰阳性球菌的菌群分布为金黄色葡萄球菌17.8%,凝固酶阴性葡萄球菌5.4%,肠球菌属7.8%,未见对万古霉素耐药的革兰阳性菌。结论糖尿病足溃疡处感染的病原菌以革兰阴性菌为主,碳青霉烯类及万古霉素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 drug resistance of pathogens isolated from diabetic foot ulcer. Methods A retrospective study was carried out on the distribution and resistance rates in 129 strain pathogens, from 2003 to 2005, isolated from diabetic foot ulcer. Results The infections were increasing during 2003-2005, of the 129 strains, 63.6 were Gram-negative bacteria, 31.8% were Gram-positive, and 5. 4% were candida infection. Candida albicans was the common pathogen. Other pathogens included Escheriohia coil （ 24. 8 %）, Proteus spp （ 10. 9 %）, Pseudomonas aeruginosa （ 17. 0 %）, Stenotrophomonas maltophilia （3.1% ）, Enterobacter spp （7.80% ）, Staphylococcus aureus （17.8%）, Coagulase-negative staphylococci （5.4%）, and Enterococcus spp （7.8 % ）. Imipenem and Cefoperazone-sulbactam were highly active against Enterobacteriaceae. Vancomycin-resistant staphylococci were not found. Conclusion The most common pathogens causing the infection are Gram-negative bacteria. Imipenem and vancomycin are highly active against them. Uninterruptedly monitor the pathogens and their drug resistance in diabetic foot ulcer infection may provide evidence for treating the ulcer infection.