120例糖尿病足感染患者病原菌分布特点及药敏分析

Distribution and antimicrobial resistance of pathogens isolated from 120 patients with diabetic foot infection

目的了解青岛地区糖尿病足(DF)合并感染的病原菌分布及药物敏感情况。方法选取2013年12月至2015年12月于青岛内分泌糖尿病医院住院的120例糖尿病足感染患者,分析其病原菌分布特点及药物敏感性,及病原菌分布与DF严重性的关系。结果 120例DF患者足部分泌物培养出病原菌103株,阳性率为85.83%。其中,革兰阳性球菌65株,占63.11%(65/103),革兰阴性杆菌38株,占36.89%(38/103)。混合菌感染患者24例,占20.00%(24/120),其中16例Wagner分级≥3级,占66.67%(16/24)。感染的病原菌主要有金黄色葡萄球菌、表皮葡萄球菌、变形杆菌、大肠埃希菌。革兰阴性杆菌对泰能、阿米卡星、哌拉西林较为敏感;对头孢唑林、氨苄西林大多耐药。革兰阳性球菌对庆大霉素、替考拉宁、莫西沙星较敏感,而对青霉素、大环内酯类大多耐药。结论糖尿病足感染的病原菌分布广泛,耐药率高,且随着感染加重,革兰阴性杆菌逐渐占据主导地位。临床治疗中,在积极降糖治疗的同时,尽早、多次行分泌物病原学检查及早期联合选择敏感抗菌药物治疗至关重要。

Objective To study the distribution and antimicrobial resistance of pathogens isolatedfrom 120 patients with diabetic foot infection. Methods Totally 120 patients with DF were enrolledin our study. Pathogenic distributions and antimicrobial sensitivities, the relationship betweenthe pathogenic bacteria distribution and DF severity were analyzed. Results From 120 patientswith DF,103 strains of pathogenic becteria were isolated and the positive rate was 85. 8 3 % ,including 65 strains Gram-positive Bacteria （ 63. 11 % , 65/103 ）, 38 strains Gram-negative Bacilli（36. 89 % ,38/103）. There were 24 cases（20. 0 0 % , 24/120） patients with polymicrobial infection,and 16 cases （66. 6 7 % , 16/24） patients with polymicrobial were with Wagner？ s grade^ 3 . Themain bacteria were staphylococcus aureus, staphylococcus epidermis, proteusbacillus vulgaris andEscherichia coli. Gram negative bacilli were sensitive to tienam, amikacin and piperacillin whilethey were resistant to cefazolin and ampicillin. Gram positive coccus were sensitive to gentamicin,teicoplanin and moxifloxacin while they were resistant to penicillin and macrolide antibiotics.Conclusion The pathogenic bacteria in DF infection distribute extensively and some of them aremulti-drug resistant. With the infection worsening, Gram negative bacilli has gradually dominatedthe infection. In the clinical treatment, at the same time of hypoglycemic therapy,combining applicationof sensitive antimicrobial agents is the key to the treatment of DF infection.