糖尿病足湿性坏疽多重耐药菌耐药特点分析

Analysis on drug resistance characteristics of multi-drug resistant bacteria in diabetic feet with moist gangrene

目的探讨糖尿病足湿性坏疽多重耐药菌的分布特点及耐药情况。方法选择2010年1月至2014年12月该院脉管炎科及糖尿病科送检的糖尿病足湿性坏疽患者分泌物1 845份,分离多重耐药菌,分析其分布情况及革兰阴性菌、革兰阳性菌、厌氧菌、真菌的多重耐药特点。结果分离出465株多重耐药菌株中,革兰阴性杆菌274株(58.92%),革兰阳性球菌191株(41.08%)。革兰阴性多重耐药菌株中以大肠埃希菌株为主占37.60%,革兰阳性多重耐药菌株中以凝固酶阴性葡萄球菌为主占51.30%;多重耐药阴性杆菌中,产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌及肺炎克雷伯菌、鲍曼溶血不动杆菌、铜绿假单胞菌表现高耐药性,耐药率达到50.00%以上;多重耐药阳性球菌中,凝固酶阴性葡萄球菌及金黄色葡萄球菌均为耐甲氧西林阳性菌株,这些菌株表现高耐药性,耐药率达85.00%以上。结论糖尿病足湿性坏疽多重耐药菌中大肠埃希菌、肺炎克雷伯菌、凝固酶阴性葡萄球菌及金黄色葡萄球菌表现高耐药性,临床应结合耐药鉴定分析选择用药。

Objective To investigate the distribution characteristics and drug resistance situation of multi-drug resistant bacteria in diabetic feet with moist gangrene.Methods 1 845 samples of secretion from the patients with diabetic feet complicating moist gangrene in the vasculitis department of our hospital from January 2010 to December2014were selected for isolating the multi-drug resistant bacteria.Their distribution and the multi-drug resistant characteristics of Gram-negative bacteria,Gram-positive bacteria,anaerobion and fungi were analyzed.Results Among isolated 465 strains of multi-drug resistant bacteria,274strains（58.92%）were Gram-negative bacteria and 191strains（41.08%）were Gram-positive cocci.Most of multi-drug resistant Gram-negative bacteria were Escherichia coli（37.60%）and most of multi-resistant Gram-positive bacteria were coagulase-negative staphylococci（51.30%）;among multi-drug resistant Gram-negative bacteria,ESBLs-producing Escherichia coli and Klebsiella pneumoniae,Acinetobacter Baumann hemolysis,Pseudomonas aeruginosa showed highly drug resistance,the drug resistance rate reached more than 50.00%;among multi-drug resistant Gram-positive cocci,coagulase-negative staphylococci and Staphylococcus aureus were methicillin-resistant strains,these strains showed the high drug resistance,the drug resistance rate reached up to more than 85.00%.Conclusion Among multi-drug resistant bacteria in diabetic feet with moist gangrene,Escherichia coli,Klebsiella pneumoniae,coagulase-negative staphylococci and Staphylococcus aureus display high drug resistance rate,clinic should select antibacterial drugs by combining with the drug resistance identification and analysis.