544例糖尿病足感染患者的病原菌特点及药敏分析

Analysis on the antimicrobial resistance and the characteristic of pathogenic bacteria isolated from 544 patients with diabetic foot

目的了解糖尿病足(DF)合并感染患者的病原菌分布与药物敏感性,指导临床合理使用抗菌药物。方法对544例DF感染患者的创面分泌物进行病原菌培养和药敏结果分析。结果 544例DF患者分泌物样本中培养出病原菌477株,阳性率为87.68%。其中革兰阳性球菌129株,占27.04%(129/477),革兰阳性链球菌(包括肠球菌)47株,占9.85%(47/477),革兰阴性杆菌159株,占33.33%(159/477),真菌35株,占7.33%(35/477),类白喉杆菌65株,占13.63%(65/477)。单一菌感染患者162例,占29.78%(162/544),混合菌感染患者144例,占26.47%(144/544),混合菌感染者中W agner分级≥3级的DF患者为130例,占90.28%(130/144)。其中葡萄球菌对万古霉素、呋喃妥因、喹奴普汀-达福普汀较敏感;革兰阴性杆菌对亚胺培南(嗜麦芽窄食单胞菌除外)及加β-内酰胺酶抑制剂的抗菌药物较为敏感。结论 DF感染的病原菌分布广泛,对抗菌药物耐药率高,早期联合选择敏感抗菌药物治疗是DF感染治疗的关键。

Objective To study the antimicrobial sensitivity and the distribution of pathogenic bacteria isolated from patients with diabetic foot（DF） and use antibiotics rationally.Methods Totally 544 patients with DF were enrolled in our study.Specimens such as pus and wound exudate were collected for culture.Pathogenic distributions and antimicrobial sensitivities were analyzed.Results From 544 patients with DF,477 strains of pathogenic becteria were isolated and the positive rate was 87.68%,including 129（27.04%,129/477） Gram-positive Bacteria,47（9.85%,47/477） Gram-positive Streptococcus（including Enterococcus）,159（33.33%,159/477） Gram-negative Bacilli,35（7.33%,35/477） Fungi and 65（13.63%,65/477） Diphtheroid bacilli.There were 162（29.78%,162/544） patients with single microbial infection and 144（26.47%,144/544） patients with polymicrobial infection,and 130（90.28%,130/144） patients with polymicrobial were with Wagner′s grade≥3.Staphylococcus was sensitive to vancomycin,nitrofurantoin and quinupristin-dalfo.Gram-negative Bacilli were sensitive to imipenem（except Stenotrophomonas maltophilia） and beta-lactamases inhibitor.Conclusions The pathogenic bacteria in DF infection distribute extensively and some of them are multidrug resistant.The key to the treatment of DF infection is early combined application of sensitive antimicrobial agents.