糖尿病并发败血症病原菌分布及耐药性

Distribution and drug resistance of pathogens causing sepsis in diabetes patients

目的分析糖尿病合并败血症患者的病原菌种类及其对抗菌药物的耐药性,为合理选用抗菌药物提供依据。方法对2011年1月至2014年7月在浙江大学医学院附属第二医院确诊的80例糖尿病合并败血症患者的临床资料、血培养和药敏结果进行回顾性分析。结果 80例糖尿病合并败血症患者中原发感染部位以泌尿道感染最多,其次为呼吸道感染。检出病原菌中革兰阴性菌44株,占55.0%,其中大肠埃希菌38株,肺炎克雷伯菌6株;革兰阳性菌36株,占45.0%,其中葡萄球菌属24株,链球菌属12株。药敏试验中大肠埃希菌对环丙沙星、左氧氟沙星、氨苄西林和哌拉西林耐药率达50.0%以上;肺炎克雷伯菌对氨苄西林、环丙沙星、左氧氟沙星、呋喃妥因、哌拉西林、头孢西丁、头孢唑林、头孢呋辛和妥布霉素100.0%耐药;葡萄球菌属对苯唑西林、克林霉素和青霉素G耐药率高达75.0%以上。结论糖尿病并发败血症患者以革兰阴性杆菌感染为主,但革兰阳性菌感染率与以往报道比有上升趋势,可选用碳青霉烯类抗菌药物以及头孢含β-内酰胺酶抑制剂的复合药作为经验性治疗,考虑阳性菌感染时首选万古霉素,同时要尽早行血培养,及时更换为敏感抗生素,减少耐药菌株的出现,降低糖尿病合并败血症的病死率。

Objective To analyse the type of pathogens and their resistance to antimicrobial agents in diabetes mellitus patients with sepsis,and provide a basis for the rational use of antimicrobial drugs.Methods The clinical data,blood cultures and drug susceptibility of 80 cases of diagnosed diabetes mellitus with sepsis in our hospital from January 2011 to July 2014 were retrospectively analysed.Results In the 80 diabetes mellitus patients with sepsis,urinary tract infections were the main type,followed by respiratory infections.Forty-four Gram-negative bacteria（55.0%）were detected,of which 38 were Escherichia coli,and 6 were Klebsiella pneumonia.Thirty-six Gram-positive bacteria（45.0%）were detected,of which 24 were Staphylococcus,and the other 12 were Streptococcus.The resistance rates of Escherichia coli to Ciprofloxacin,Levofloxacin,Ampicillin and Piperacillin were all above 50.0%;the resistance rates of Klebsiella pneumonia to Ampicillin,Ciprofloxacin,Levofloxacin,Furadantin,Piperacillin,Cefoxitin,Cefazolin,Cefuroxime and Tobramycin were all 100.0%;the resistance rates of Staphylococcus to Oxacillin,Clindamycin and Penicillin G were up to 75.0% or over.Conclusion Gram-negative bacilli infection is the main type in diabetes patients with sepsis,but the incidence of Gram-positive bacteria infections is on the rise.Carbapenems,cephalosporins and compound drugs containing beta lactamase inhibitor can be used as empirical therapy.For positive bacteria infections,vancomycin can be the first choice.At the same time,blood culture should be performed as soon as possible,and sensitive antibiotics be used in order to reduce the emergence of resistant strains and the mortality of diabetes mellitus patients with sepsis.