糖尿病患者发生败血症病原菌分布及药敏性分析

Distribution of pathogens causing sepsis in diabetes patients and analysis of drug susceptibility

目的分析糖尿病发生败血症患者的病原菌种类及其对抗菌药物的敏感性,为糖尿病发生败血症患者的早期诊断以及合理选用抗菌药物提供依据。方法回顾性分析医院分泌科2006年8月-2012年3月54例糖尿病发生败血症患者的临床资料。结果 54例糖尿病发生败血症患者共分离出病原菌54株,其中革兰阳性菌8株,占14.8%,革兰阴性菌44株,占81.5%,真菌2株,占3.7%;感染部位以呼吸道感染最多23例,占42.6%,其次为泌尿道感染18例,占33.3%;肺炎克雷伯菌对哌拉西林/他唑巴坦、头孢噻肟、氨苄西林、舒巴坦的耐药率均>80.0%,对氟喹诺酮类和阿米卡星、氨曲南的耐药率均>50.0%,对亚胺培南和美罗培南极为敏感,耐药率均为0;凝固酶阴性葡萄球菌对青霉素G、红霉素抗菌药物100.0%耐药。结论糖尿病发生败血症患者多为革兰阴性杆菌感染,主要为肺炎克雷伯菌及大肠埃希菌,尽早行血培养,对指导临床合理使用抗菌药物和控制感染十分重要。

OBJECTIVE To investigate the species of pathogens causing sepsis in the patients with diabetes and analyze the drug susceptibility so as to provide basis for the early diagnosis of sepsis and the reasonable use of antibiotics. METHODS The clinical data of 54 cases of diabetes patients with sepsis who were treated in the endocrinology department from Aug 2006 to Mar 2012 were retrospectively analyzed. RESULTS Totally 54 strains of pathogens were isolated from the 54 diabetes patients with sepsis, among which there were 8 （14.8%） strains of gram-positive bacteria, 44 （81.5%） strains of gram-negative bacteria, and 2 （3.7%） strains of fungi. Among the patients with infections of different sites, there were 23 （42.6 %） cases of respiratory tract infections and 18 （33.3%） cases of urinary tract infections. The drug resistance rates of the Klebsiella pneumoniae to piperacillin- tazobactam, ampicillin, cefotaxime, and sulbactam were more than 80. 0%, the drug resistance rates to fluoroquinolones, amikacin, and aztreonam were more than 50.0 %, and the strains were extremely susceptible to imipenem and meropenem, with the drug resistance rates of 0; the drug resistance rates of the coagulase-negative Staphylococcus to penicillin G and erythromycin were 100. 0%. CONCLUSION The gram-negative bacilli are the predominant pathogens causing sepsis in the diabetes patients , among which the K. pneurnoniae and Escherichia coli are dominant, and it is of great significance for the guidance of reasonable clinical use of antibiotics and the infection control to perform blood culture as early as possible.