糖尿病足感染患者病原菌分布及其药物敏感试验

The distribution of causative pathogens and their drug susceptibilities in diabetic foot infections

目的：探讨不同 Wagner 分级的糖尿病足感染的主要病原菌分布及其药物敏感试验特点。方法回顾性分析空军总医院2012年1月至2014年12月收治的705例糖尿病足患者的足部分泌物培养结果，以及药物敏感试验结果。计数资料比较采用χ2检验。结果共收集705例糖尿病足患者1343份标本，细菌培养阳性991份，阳性率为73．8％。其中，革兰阳性菌358株，革兰阴性菌586株，真菌47株；居前三位的细菌依次为铜绿假单胞菌（21．2％）、鲍曼不动杆菌（20．1％）和金黄色葡萄球菌（12．3％）。轻度糖尿病足患者（Wagner 1、2级）革兰阳性菌和革兰阴性菌感染率分别为48．33％（29／60）和46．67％（28／60），中、重度糖尿病足患者（Wagner 3、4、5级）分别为35．34％（329／931）和59．94％（558／931），差异有统计学意义（χ^2＝4．324，P＝0．038）。轻、中、重度糖尿病足患者病原菌混合感染率分别为3．41％、7．84％和13．84％，差异有统计学意义（χ^2＝11．353，P ＝0．003）。革兰阴性菌中以铜绿假单胞菌、鲍曼不动杆菌感染为主，铜绿假单胞菌对亚胺培南、哌拉西林／他唑巴坦、头孢他啶的敏感率较高，分别为25．84％、24．76％和23．92％；鲍曼不动杆菌对复方新诺明、亚胺培南、头孢哌酮／舒巴坦的敏感率较高，分别为41．71％、25．13％和24．29％。革兰阳性菌以金黄色葡萄球菌、粪肠球菌感染为主，金黄色葡萄球菌对替加环素和万古霉素红的敏感率均为100．00％；粪肠球菌对替加环素和利奈唑胺的敏感率均为100．00％。结论不同程度糖尿病足患者感染的病原菌分布不同，且病原菌对多种抗菌药物敏感性不高。

Objective To investigate the main causative pathogens and their drug susceptibility patterns in diabetic foot infections with different Wagner grades .Methods The bacterial culture results and drug susceptibilities of 705 patients with diabetic foot infections at the Air Force General Hospital from January 2012 to December 2014 were retrospectively analyzed .Enumeration data were compared with Chi‐square test . Results Of 1 343 samples collected from 705 patients with diabetic foot ,991 samples revealed pathogen growth .The positive rate was 73 .8% .In culture‐positive samples ,358 strains were gram‐positive ,586 stains were gram‐negative ,whereas 47 strains were fungi . Pseudomonas aeruginosa , Baumanii and Staphylococcus aureus were dominant .The proportions of gram‐positive and gram‐negative bacteria in patients with Wagner 1 - 2 were 48 .33% （29/60 ） and 46 .67% （28/60 ） ,respectively ,and 35 .34% （329/931） and 59 .94% （558/931） ,respectively in those with Wagner 3 - 5 （χ^2 = 4 .324 , P =0 .038） .The composite infection in patients with mild ,moderate and sever diabetic foot were 3 .41% , 7 .84% ,and 13 .84% , respectively （χ^2 = 11 .353 , P = 0 .003 ） . Among gram‐negative bacteria , Pseudomonas aeruginosa and Baumanii were dominating floras . Susceptibilities of Pseudomonas＆amp;nbsp;aeruginosa to imipenem ,piperacillin/tazobactam and ceftazidime were 25 .8% ,24 .76% and 23 .92% , respectively , while susceptibilities of Baumanii to trimethoprim /sulphamethoxazole , imipenem and cefoperazone/sulbactam were 41 .71% ,25 .13% and 24 .29% ,respectively . Staphylococcus aureus and Enterococcus f aecalis were found to be prevalent among gram‐positive bacteria . Staphylococcus aureus was most susceptible to tigecycline and vancomycin （both 100 .00% ） ,and Enterococcus f aecalis was most susceptible to tigecycline and linezolid （both 100 .00% ） .Conclusions The distribution of pathogenic bacteria in diabetic foot infections patients different Wagner grades varies significantly , and causative pathogens are resistant to multiple antimicrobial drugs .