2型糖尿病患者并发院外获得性败血症24例的临床分析

Type 2 diabetes mellitus complicated by community acquired sepsis:A clinical analysis of 24 cases

目的:探讨2型糖尿病合并院外获得性败血症的临床特点,以提高临床诊断治疗水平。方法:对24例2型糖尿病合并院外获得性败血症患者的临床资料进行总结分析。结果:临床症状上,22例有发热(高热16例,间歇热14例,伴寒战14例),白细胞总数平均13.6×109/L,中性粒细胞比率平均84.5%。细菌学上,革兰阳性球菌11例,其中人葡萄球菌6例(耐甲氧西林金黄色葡萄球菌2例),金黄色葡萄球菌2例,沃氏葡萄球菌、屎肠球菌、狗链球菌各1例。革兰阴性杆菌13例,其中肺炎克雷伯菌5例,大肠埃希菌5例(超广谱β-内酰胺酶1例),粘质沙雷菌、弗氏柠檬酸杆菌群、亚利桑那沙门菌各1例。杆菌主要来源于尿道(7例),其次来源于肺(2例)、肝(2例),另有2例来源不明。球菌主要来源于肺内和皮肤。患者入院时血糖水平较高,空腹血糖(16.53±5.28)mmol/L,餐后血糖(19.62±8.40)mmol/L,糖化血红蛋白(9.55±2.94)%;经过胰岛素治疗血糖降至接受范围,空腹为(6.5±2.3)mmol/L,餐后为(9.8±2.8)mmol/L。仅1例因放弃治疗于出院后死亡,余23例均获得满意的治疗效果。结论:2型糖尿病合并院外获得性败血症仍以革兰阴性杆菌略多见,主要为肺炎克雷伯菌和大肠埃希菌,革兰阳性球菌中人葡萄球菌较常见。及早诊断,积极抗感染的同时需要积极的胰岛素控制血糖,利于改善预后。

Objective ： To investigate the clinical characteristics of community acquired sepsis in patients with type 2 diabetes mellitus. Methods ： A retrospective study was conducted on 24 type 2 diabetic patients complicated by community acquired sepsis. Results： All the patients had fever, 16 between 39.1 ℃ and 41.0℃, 14 of intermittent character and 14 with chills. White blood cell count averaged at 13.6 × 10^9/L and neutrophil 0. 845%. Bacteriologically, gram positive cocci were observed in 11 isolates, incuding 6 cases of staphylococcus huminis （2 with MRSA） and 2 cases of staphylococcus aureus, and gram negative bacilli were found in 13, including 5 cases of klebsiella pneumoniae and 5 cases of escherichia coli （ 1 with ESBL）. Pulmonary and skin infections were the main sources of cocci, while urinary tract infection was that of bacilli. The patients all had high blood glucose levels upon admission, with FBGat （16.53 ±5.28） mmol/L, PBG at （19.62 ±8.40） mmol/L and HbAlc at （9.55 ± 2.94） %, the first two indexes reduced to （6.5 ± 2.3 ） mmol/L and （9.8 ± 2.8 ） mmol/L after insulin administration. All the patients achieved satisfactory therapeutic results except 1 who died because of abandonment of medication. Conclusion ： Community acquired sepsis in type 2 diabetic patients is commonly associated with gram negative bacilli, with klebsiella pneumoniae, escherichia coli and staphylococci huminis as the major pathogens. Early diagnosis, timely antibiotic treatment and effective control of blood glucose with insulin may contribute to better prognosis.