230例糖尿病足部溃疡感染病原菌分布及药物敏感性分析

Distribution of Pathogens & Analysis of Drug Susceptibility on 230 Cases with Diabetic Foot Ulcer Infection

分析近2 a糖尿病足患者足部感染常见病原菌分布及抗菌药物敏感性,为临床合理选择抗菌药物提供参考依据。回顾性分析了2011年6月至2012年12月天津中医药大学第二附属医院门诊及住院糖尿病足感染患者病例资料。全部细菌中革兰阴性菌138株(59.0%),革兰阳性菌94株(40.2%),真菌2株(0.8%)。培养阳性率为95.22%,占前3位的细菌为金黄色葡萄球菌(下称金葡菌)、奇异变形杆菌、肺炎克雷伯菌。产ESBL(超广谱β-内酰胺酶)菌株共9株,占全部革兰阴性菌的6.52%,肠杆菌科细菌对亚胺培南、美罗培南均敏感,铜绿假单胞菌对阿米卡星、头孢吡肟、头孢哌酮/舒巴坦均敏感。金葡菌中MRSA(甲氧西林耐药金葡菌)占19.6%,克林霉素诱导实验(D-实验)阳性的金葡菌的占27.5%。在粪肠球菌中,高水平庆大霉素耐药菌株(HLGR)和高水平链霉素耐药菌株(HLSR)分别占50%及20%。万古霉素与利奈唑胺对所感染的阳性球菌均敏感。结果表明,糖尿病足部溃疡患者应及时进行微生物学检查、耐药类型鉴定和药敏实验,对耐药菌株给予高度重视,并根据药敏结果合理应用抗菌药物以减少耐药菌的产生。

The distribution of common pathogens and drug susceptibility on patients with diabetic foot（DF） ulcer infection in near two years were analyzed to provide a guideline in choosing reasonable antibiotics clinically.Cases data with DF infections from June 2011 to Dec.2012 collected in the 2nd Affiliated Hospital of Tianjin University of TCM were reviewed and analyzed the distribution and sensitivity rates of pathogens isolated from outpatients and inpatients of.In all detected strains,138（59.0%） were Gram negative bacteria,94（40.2%） Gram positive bacteria,and 2（0.8%） fungi.The culture-positive rate was 95.22%.Staphylococcus aureus（Sa）,Proteus mirabilis and Klebsiella pneumoniae ranked the top three of all.There were 9 ESBL-producing strains,accounting for 6.52% of G-bacteria.Enterobacteriaceae was sensitive to imipenem,meropenem.Pseudomonas aeruginosa was sensitive to amikacin,cefepime and cefoperazone /sulbactam.MRSA accounted for 19.6% in all Sa strains.D-test positive Sa strains were 27.5%.In Enterococcus faecalis,the percentages of HLGR（high level gentamycin resistant） and HLSR（high level streptomycin resistant） strains were 50% and 20%,respectively.All the detected G＋ cocci were sensitive to vancomycin and linezolid.Microbiological examination,resistance analysis and drug sensitive test should be carried out for the patients with DF ulcer as soon as possible,and the detected drug resistant strains should be paid attention to.Moreover,a guideline in choosing antibiotics reasonably according to the results should be provided in order to reduce the emergence of drug resistant pathogens.