糖尿病足感染的特点与治疗

Characteristics of diabetic foot infections and anti-infection treatment

目的探索糖尿病足感染中病原菌谱变化规律及主要感染病原菌对抗菌药物敏感率,以期选择最优的抗感染方案。方法收集、对比空军总医院内分泌科1997-2010年糖尿病足感染病原菌培养结果,确定糖尿病足感染病原菌谱变迁及主要感染病原菌对抗菌药物敏感状况。结果糖尿病足感染革兰阴性菌感染逐年下降,从1997年的59.4%下降至2010年的43.5%;革兰阳性菌感染逐年上升,从1997年的40.6%上升至2010年的45.2%,对大部分抗菌药物敏感;铜绿假单胞菌感染明显减少,从1997年18.8%下降至2010年的11.3%;真菌感染比例有升高,从2006年1.9%上升至2010年的11.3%。结论糖尿病足感染的病原菌谱随时间变迁而改变,同阶段患足局部感染病原菌的种类可能不同,或者同一种病原菌在不同阶段对一种抗菌药物的敏感度不同;应多次进行创面病原菌培养及药物敏感试验,合理使用抗菌药物。

OBJECTIVE To explore the change of the bacterial spectrum in the patients with diabetic foot infections and the antibiotics susceptibility of the main pathogens,in order to choose the best anti-infection program.METHODS The diabetic foot infectious bacteria culture results of the Air Force General Hospital from 1997 to 2010 were collected and compared,the bacterial spectrum change of the pathogens causing diabetic foot infections was determined and the drug susceptibility of the main pathogens was analyzed.RESULTS The diabetic foot infections caused by gram-negative bacteria decreased from 59.4% in 1997 to 43.5% in 2010;the infections caused by gram-positive bacteria increased from 40.6% to 45.2%,they were suscertible to most antibiotics;Pseudomonas aeruginosa infections decreased significantly from 18.8% in 1997 to 11.3% in 2010.The proportion of the fungal infections increased from 1.9% in 2006 to 11.3% in 2010.CONCLUSION The bacterial spectrum of the pathogens causing diabetic foot infections changes with time,the pathogens causing local foot infections in the same stage may be different in the species or the drug susceptibility to the same antibiotics at various stages;it is necessary to frequently perform the wound culture and drug susceptibility testing as well as reasonably use of antibiotics.