糖尿病足多药耐药菌感染的耐药性及易感因素分析

Antibiotic resistance and predisposing factors of the patients with diabetic foot ulcer infected by multi-drug resistant microorganisms

目的分析糖尿病足溃疡感染多药耐药菌（MDROs）的分布及耐药性,初步探讨MDROs易感因素,为临床有效控制MDRMs提供依据。方法对2011年1月-2012年1月收治的157例糖尿病足溃疡患者临床资料进行回顾性分析,细菌分离按《全国临床检验操作规程》,细菌鉴定采用法国生物梅里埃公司的VITEK-2全自动细菌分析仪进行,K-B纸片扩散法进行药敏试验,采用SPSS 17.0软件对数据进行统计处理,MDROs易感因素采用单因素分析。结果 118例糖尿病足溃疡感染患者足分泌物共分离出146株病原菌,其中MDROs检出78株,检出率为53.4%;居前3位的MDROs分别为金黄色葡萄球菌13株、肠杆菌属13株、铜绿假单胞菌12株,分别占16.7%、16.7%、15.3%;MDROs革兰阴性菌对阿米卡星和氟喹诺酮类敏感,对三代头孢耐药率为23.0%～50.0%,肠杆菌科细菌对亚胺培南的耐药率为15.4%,而铜绿假单胞菌的耐药率为8.3%,革兰阳性菌对喹诺酮类耐药率均〉70.0%,对青霉素和半合成青霉素耐药率为57.0%～100.0%,多药耐药肠球菌对万古霉素耐药率为28.6%,未发现耐万古霉素葡萄球菌。结论糖尿病足溃疡中MDROs耐药性较严重,及时进行正确的细菌培养及药敏检测,可以指导临床合理用药以减少耐药菌的产生及播散。

OBJECTIVE To analyze the distribution and resistance characteristics of multi-resistant bacteria（MDROs）,discuss predisposing factors of diabetic foot ulcer with MDROs,so that to provide the reference for controlling the infection of MDROs.METHODS The clinical data of 157 patients with diabetic foot ulcer admitted to Tianjin Metabolic Diseases Hospital between Jan.2011 and Jan.2012 were retrospectively analyzed.Bacteria were isolated by the National Clinical Laboratory Procedures.Bacteria were identified by the French company BioMerieux VITEK-2automatic bacterial analyzer.Susceptibility test was carried by K-B disk diffusion method.The data were dealt with SPSS 17.0software.RESULTS A total of 78 MDROs strains were isolated from 157 specimens with isolation rate of 53.4%,among which the top three were Staphylococcus aureus of 13cases（16.7%）,Enterobacter of 13cases（16.7%）,Pseudomonas aeruginosa of 12cases（15.3%）.Gram-negative MDROs were sensitive to amikacin and fluoroquinolone,and resistant to third generation cephalosporins with resistant rate of 23.0%-50.0%.The resistant rates of Enterobacter and Pseudomonas aeruginosa to imipenem were 15.4%and 8.3%respectively.The resistant rates of gram-positive MDROs to fluoroquinolone were more than 70.0%,and to penicillin and semi-synthetic penicillin were 57.0%-100.0%.Multidrug-resistant Enterococci resistant to vancomycin were 28.6%.None of Staphylococcus was found resistant to vancomycin.CONCLUSION Multi-drug resistant problems of MDROs in diabetic foot ulcer were serious.It is important to survey pathogens and their antibiotic resistance correctly in diabetic foot patients to provide evidences for clinical drug administration and reduce the dissemination of drug resistant strains.