糖尿病足溃疡感染多重耐药菌的临床特点及相关因素分析

Clinical characteristics and related factors of diabetic foot ulcer with multi-drug resistant microorganisms infection

目的探讨糖尿病足溃疡(diabetic foot ulcer,DFU)感染多重耐药菌(MDROs)的分布特点、DFU感染MDROs的危险因素及对DFU结局的影响。方法对我院收治的157例DFU患者临床病例资料进行回顾性分析。以是否感染MDROs分为两组,采用χ2检验,t检验进行MDROs感染及糖尿病足溃疡结局的单因素分析,logistics回归进行MDROs感染的危险因素分析。结果 MDRO阳性组中共分离出MDROs78株,居前三位分别是金黄色葡萄球菌16.7%(13/78)、肠杆菌16.7%(13/78)、铜绿假单孢菌15.4%(12/78)。MDROs感染的单因素分析,两组在糖尿病病程、入院前住院次数、入院前抗生素应用时间、溃疡类型、溃疡大小及骨髓炎方面差异有统计学意义,而logistics回归分析,入院前住院次数、入院前抗生素应用时间、溃疡类型、溃疡大小、骨髓炎是MDROs感染的独立危险因素。MDRO阳性组截肢率高于MDRO阴性组(60.9%vs 37.0%,P<0.05)。结论入院前住院次数、入院前抗生素应用时间、溃疡类型、溃疡大小及骨髓炎是DFU感染MDROs的独立危险因素,感染MDROs影响溃疡的结局,增加截肢的风险,更好的控制MDROs是改善DFU预后的重要途径。

Objective To determine the clinical characteristics and related risk factors of diabetic foot ulcers with multi-drug resistant microorganisms（MDROs） as well as the influence of MDROs to the results of DFU. Methods The clinical data of 157 patients with DFU admitted to the hospital were retrospectively analyzed. The patients were divided into two groups according to the infection of MDROs;Chi-square test and independent sample t-test were applied in univariate analysis. Logistic regression was applied in multivariable analysis of risk factors for the infection of MDROs. Results 78 MDROs strains were isolated from patients in the MDRO＋ group, among which the top three were Staphylococcus aureus （ 16.7 % ）, Enterobacter （ 16.7 % ）, Pseudomonas aeruginosa （ 15.4 % ）. Course of diabetic disease, frequency of hospitalization, previous duration of antibiotic therapy, ulcer type, ulcer size and osteomyelitis were risk factors for MDROs, while the frequency of hospitalization, previous duration of antibiotic therapy,ulcer type, ulcer size and osteomyelitis were independent risk factors. The amputation （including minor amputation and major amputation） rate in MDRO＋ group was significantly higher than that in MDRO group （60.9% vs 37.0%, P = 0. 016）. Conclusion The frequency of hospitalization for the same wound, previous duration of antibiotic therapy, ulcer type,ulcer size and osteomyelitis are independent risk factors of patients with DFU infected MDROs. MDROs affect the outcome of DFU,increase the risk of amputation, controlling the infection of MDROs is better for improving the prognosis of DFU.