125例糖尿病足感染患者病原菌分布及耐药性分析

Distribution and resistance surveillance of pathogens causing diabetic foot infections in 125 cases

目的:分析糖尿病足部感染临床分离病原菌的分布及其抗菌药物敏感性特点,为临床医务工作者合理应用抗菌药物提供理论依据。方法:选取2011年1月至2014年9月,来本院治疗的糖尿病足合并感染患者125例,采集糖尿病足部溃疡分泌物,并保存培养分离出的病原菌,采用琼脂倍比稀释法进行药物敏感试验,药敏结果依据美国临床实验室标准化委员会2013年推荐的标准进行判读。结果:125例糖尿病足感染患者溃疡分泌物共培养分离出病原菌132株,其中,革兰阳性菌62株(47.0%),革兰阴性菌55株(41.7%),真菌15株(11.4%)。革兰阴性菌对碳青霉烯类抗菌药物和含β-内酰胺酶抑制剂的药物敏感性相对较高;革兰阳性菌对糖肽类抗菌药物、碳青霉烯类抗菌药物、氨基糖苷类药物的敏感性相对较高;真菌则对两性霉素B和卡泊芬净敏感度最高。结论:感染是糖尿病足患者病情加重的一个重要因素,对于糖尿病足部感染患者要尽早并多次进行分泌物的病原菌分离和药敏试验,以指导临床工作者筛选敏感的抗菌药物进行针对性治疗,减少耐药菌的产生。

Objective： To analyze the clinical distribution and antimicrobial resistance of pathogens causing diabetic foot infections in order to provide the basis for clinical rational choice of antibiotics. Methods： A total of 125 cases of diabetic foot infection were chosen from January 2011 to September 2014. The clinical data were retrospective analysed. The antimicrobial susceptibility test to isolated pathogens was performed by agar dilution method. The results were judged according to the criteria recommended by Clinical and Laboratory Standards Institute （CLSI） 2013. Results： Of 125 cases of diabetic foot infection, 132 strains were isolated, in which 62 were Grampositive bacteria （47.0%）, SS Gram-negative bacteria （41.7%）, and 15 fungi （11.4%）. The results of antimicrobial susceptibility test showed that Gram-negative bacteria were highly susceptible to the carbapenem and β-lactamase inhibitor; Gram-positive bacteria were highly susceptible to the glycopeptide, carbapenem and aminoglycoside; fungus was susceptible to amphotericin B and caspofungin. Conclusion： For patients with diabetic foot infections, repeated detection of pathogens in secretions is very important. The surveillance of antimicrobial resistance should be strengthened for purpose of preventing the transmission of multidrug resistant strains.