糖尿病足感染多药耐药菌的分布及耐药性与危险因素分析

Distribution and drug resistance of multidrug-resistant bacteria causing diabetic foot infections and risk factors

目的探讨糖尿病足感染多药耐药菌(MDRMs)的分布与耐药性及危险因素,以期为临床防治提供参考。方法选取96例糖尿病足感染患者,进行感染部位病原菌检测及药敏试验分析,以发生MDRMs24例为病例组,以敏感菌感染32例为对照组,对两组患者临床资料进行对比分析。结果 96例患者糖尿病足感染部位分泌物培养阳性56例,阳性率为58.33%,MDRMs阳性者24例占42.86%,32例为敏感菌占61.14%;病例组患者共分离出病原菌36株,前3位依次为金黄色葡萄球菌、铜绿假单胞菌、肠杆菌科,分别占47.22%、27.78%、16.67%;主要MDRMs对常用抗菌药物均产生了较严重的耐药性,金黄色葡萄球菌、铜绿假单胞菌、肠杆菌科对美罗培南相对敏感,铜绿假单胞菌及肠杆菌科对氨曲南相对敏感;单因素及多因素分析结果显示,长期使用抗菌药物、合并骨髓炎、神经缺血性伤口、因同一伤口住院>2次/年是引起MDRMs发生的独立危险因素(P<0.05)。结论糖尿病足感染患者合并MDRMs感染时以金黄色葡萄球菌、铜绿假单胞菌等感染多见,对多种头孢类药物普遍耐药,存在长期使用抗菌药物、合并骨髓炎、神经缺血性伤口、因同一伤口住院次数>2次/年是导致MDRMs感染发生的危险因素。

OBJECTIVE To investigate the distribution and drug resistance of the multidrug-resistant bacteria causing diabetic foot infections and analyze the risk factors so as to provide guidance for clinical prevention and treatment.METHODS A total of 96 patients with diabetic foot infections were enrolled in the study,then the pathogens causing different sites of infections were detected,the drug susceptibility testing was performed;totally 24 cases of multidrug-resistant bacteria infections were assigned as the case group,32 cases of susceptible bacteria infections were set as the control group;the clinical data were observed and compared between the two groups.RESULTS Totally 56 of 96patients with diabetic foot infections were cultured positive for secretions,with the positive rate of 58.33%;the multidrug-resistant bacteria were isolated from 24（42.86%）cases,and the susceptible bacteria were isolated from 32（61.14%）cases.A total of 36 strains of pathogens have been isolated from the patients in the case group,among which the Staphylococcus aureus,Pseudomonas aeruginosa,and Enterobacteriaceae ranked the top three species,accounting for 47.22%,27.78%,and 16.67%,respectively.The major species of the multidrug-resistant bacteria were highly resistant to the commonly used antibiotics;the S.aureus,P.aeruginosa,and Enterobacteriaceae were relatively susceptible to meropenem;P.aeruginosaand Enterobacteriaceae were relatively susceptible to aztreonam.The results of the univariate and multivariate analysis indicated that the long-term use of antibiotics,complication of osteomyelitis,neurological ischemic wound,and frequency of hospitalization more than twice a year due to the same wound were the independent risk factors for the multidrugresistant bacteria infections（P〈0.05）.CONCLUSIONThe S.aureus and P.aeruginosaare the predominant species of multidrug-resistant bacteria causing the diabetic foot infections and are widely resistant to multiple cephalosporins.The long-term use of antibiotics,complication of osteomyelitis,neurological ischemic wound,and frequency of hospitalization more than twice a year due to the same wound are the risk factors for the multidrug-resistant bacteria infections.