糖尿病患者医院感染的病原菌分布与耐药性研究

Clinical analysis on distribution and drug resistance of pathogens for hospital infections in diabetic patients

目的调查糖尿病患者发生医院感染部位、病原菌分布及其耐药性,为临床预防治疗提供基础。方法选取医院普外科2010年12月-2013年11月因需手术收治的235例2型糖尿病医院感染患者为研究对象,调查分析入选患者临床资料,统计感染部位分布、病原菌种类及其对常规抗菌药物的耐药性,采用Microsoft Excel 2007版软件对数据进行分析。结果 235例医院感染患者中呼吸道感染占40.0%、泌尿道感染占21.3%、消化道感染占19.1%、皮肤及软组织感染占12.8%、血液感染占6.8%;共分离鉴定256株病原菌,革兰阴性菌占50.4%、革兰阳性菌占35.2%和真菌占14.4%;革兰阴性菌对多数常用抗菌药物具有较高耐药性,对头孢哌酮/舒巴坦耐药率较低,为9.8%-16.7%;对美罗培南和亚胺培南耐药率为0-4.2%;革兰阳性菌对克林霉素、万古霉素、莫西沙星和呋喃妥因耐药率较低,为10.0%-31.0%;对替考拉宁和利奈唑胺耐药率均为0。结论糖尿病合并医院感染患者感染部位以呼吸道感染为主,病原菌以革兰阴性菌为主,其对大多数常用抗菌药物有较高的耐药率,临床应参考药敏试验结果,合理选用抗菌药物。

OBJECTIVE To investigate the infected sites,distribution and drug resistance of pathogenic bacteria in patients with diabetes complicated with hospital infections,and provide bases for clinical prevention and treatment.METHODS Totally 235 cases of type 2diabetes complicated with hospital infections treated in our department from Dec.2010 to Nov.2013 were selected,and the clinical data were analyzed.Distribution of infection sites,pathogen species and resistance to common antibacterial drugs were summarized and the data were analyzed by the software Microsoft Excel（2007version）.RESULTS The 235 cases of hospital infections included respiratory tract infections（40.0%）,urinary tract infections（21.3%）,gastrointestinal tract infections（19.1%）,skin and soft tissue infections（12.8%）and blood infections（6.8%）.Totally 256 strains were identified,including gram-negative bacteria（50.4%）,gram-positive bacteria（35.2%）and fungi（14.4%）.Gram-negative bacteria had high resistance to most of common antimicrobial drug,slight resistance to cefoperazone/sulbactam（the resistance of 9.8%-16.7%）,and little resistance to meropenem and imipenem（0-4.2%）.Gram-positive bacteria was slightly resistant to clindamycin,vancomycin,moxifloxacin and nitrofurantoin（10.0%-31.0%）,and not resistant to teicoplanin and linezolid（0）.CONCLUSIONIn patients with diabetes complicated with hospital infections,the main infection site was respiratory tract,and the main pathogenic bacteria were gram-negative bacteria which showed high resistance to most of common antimicrobial drugs.Clinicians should rationally select antimicrobial drugs with reference to the result of drug sensitivity test.