糖尿病足合并感染患者532株病原菌分布及耐药性分析

Distribution and antibiotic resistance features of 532 strains of pathogens from diabetic foot infection

目的 探讨我国西南地区糖尿病足溃疡处常见病原菌分布及耐药情况.方法 回顾分析1996年1月至2009年12月在华西医院住院治疗合并足部感染的507例糖尿病足患者的资料,对溃疡处分离出的532株细菌进行病原菌分布及耐药性分析.两组间计数资料比较采用X2检验.结果 纳入的共662例患者中,507例（76.6%）存在足部感染,358例（70.6%）患者足部溃疡处分离出532株细菌.糖尿病足部感染最常见的病原菌为革兰阳性菌（G＋菌）281株（52.8%）,其次为革兰阴性菌（G-菌）206株（38.7%）,真菌45株（8.5%）.136例（26.6%）存在混合感染.G＋菌中主要有金黄色葡萄球菌（89株,16.7%）,粪肠球菌（48株,9.0%）,表皮葡萄球菌（43株,8.1%）,发现3株耐万古霉素肠球菌,10株耐甲氧西林金黄色葡萄球菌.G＋菌对氨曲南（87.7%）、红霉素（83.5%）、头孢曲松（83.2%）及青霉素（81.0%）耐药率较高,对万古霉素（2.1%）和氟哌酸（15.3%）耐药率较低;G-菌主要有大肠埃希菌（34株,6.4%）,阴沟肠杆菌（23株,4.3%）,普通变形杆菌（21株,3.9%）和肺炎克雷伯菌（21株,3.9%）;G-菌对氨苄青霉素的耐药率最高（90.2%）,其次为氨苄青霉素/青霉烷砜（75.3%）、利福平（72.5%）、青霉素（66.7%）和红霉素（60.8%）;对亚胺培南（7.8%）、丁胺卡那霉素（12.4%）和头孢泊肟（15.7%）的耐药性较低.真菌主要为白色念珠菌（13株,2.4%）.结论糖尿病足溃疡处G＋菌的感染率较G-菌高,万古霉素及亚胺培南具有较高抗菌活性.细菌耐药形势严峻,应合理使用广谱抗生素,并对细菌的耐药性进行监测.

Objective To investigate the microbiological profile and antibiotic susceptibility patterns of organisms isolated from diabetic foot ulcers.Methods A retrospective study was carried out on the microbiological profile and antibiotic susceptibility in 532 strains of pathogens isolated from 358 patients with diabetic foot ulcers in West China Hospital from January 1996 to December 2009.The data between groups was compared by using X2 test.Results Foot infection occurred in 507/662 （76.6% ） patients with diabetic foot.A total of 532 strains of pathogens were isolated from foot ulcers in 358/510 （70.6% ）patients.Gram-positive aerobes were most frequently isolated （51.4%, 281 strains）, followed by gramnegative aerobes and fungus （38.7% and 8.5%, 206 and 45 strains, respectively）.One hundred and thirty-six patients （26.6% ） showed polymicrobial involvement.Among the 281 strains Gram-positive bacteria, 89 （16.7% ） strains were Staphylococcus aureus, 48（9.0% ） strains were Enterococcus, and 43 （ 8.1% ） strains were Staphylococcus epidermidis, including three strains of vancomycin resistant Enterococci （VRE） and ten strains of methicillin resistant Staphylococcus aureus（MRSA）.Gram-positive bacteria were highly resistant to aztreonam （ 87.7% ）, erythromycin （ 83.5% ）, ceftriaxone （ 83.2% ） and penicillin （81.0%）; vancomycin and norfloxacin were the most effective agents against gram-positive bacteria.Among the 206 strains gram-negative bacteria, 34 strains （6.4% ） were Escherichia coli, 23 strains （4.32% ） were Enterobacter cloacae, 21 strains（3.9% ） were Proteus vulgaris.Gram-negative bacteria were highly resistant to ampicillin（90.2% ）, ampicillin/sulbactam （75.3% ）, rifampicin （72.5% ）, penicillin （66.7% ） and erythromycin （60.8% ）; Imipenem, amikacin sulphate and cefpodoxime were the most effective agents against gram-negative bacteria.The major fungus was Blastomyces albicans （2.4%, 13 strains ）.Conclusions Gram-positive aerobes are the predominant pathogens isolated from diabetic foot ulcers compared with gram-negative bacteria.Vancomycin and imipenem still keep highly antibacterial activity.It is very important to pay attention to pathogens survey and use antibiotics more rationally.