糖尿病足感染多药耐药菌的分布特点、耐药性及其危险因素分析

Distribution and drug resistance of multidrug-resistant organisms causing infections in diabetic foot patients and analysis of risk factors

目的研究糖尿病足感染多药耐药菌(MDRMs)分布特点、耐药性及其危险因素,为临床治疗提供依据。方法选取2013年12月-2015年12月医院收治的糖尿病足患者290例,培养患者感染部位分泌物的细菌,分析MDRNs感染率,并对MDRNs分离菌株进行药敏试验,分析培养结果,并应用Logistics回归分析糖尿病足MDRMs的危险因素。结果 130例患者检测出MDRMs,MDRMs阳性率为44.8%,共分离出159株MDRMs,以金黄色葡萄球菌、铜绿假单胞菌和大肠埃希菌为主;金黄色葡萄球菌对苯唑西林、氨苄西林/舒巴坦和头孢唑林耐药率高达100.0%,大肠埃希菌对氨苄西林、哌拉西林/他唑巴坦、头孢噻吩、头孢曲松耐药率高达100.0%,logistics多因素回归分析显示,既往使用抗菌药物、因同一伤口住院超过2次/年、合并骨髓炎、应用第3代头孢菌素、神经缺血性伤口是导致糖尿病足MDRMs的危险因素(P<0.05)。结论糖尿病足感染MDRMs以金黄色葡萄球菌最常见,既往使用抗菌药物、因同一伤口住院超过2次/年、合并骨髓炎、应用第3代头孢菌素、神经缺血性伤口是导致糖尿病足MDRMs感染的危险因素。

OBJECTIVE To explore the distribution and drug resistance of multidrug-resistant organisms（MDROs）causing infections in diabetic foot patients and analyze the risk factors so as to provide guidance for clinical treatment.METHODS A total of 290 diabetic foot patients who were treated in the hospital from Dec 2013 to Dec 2015 were enrolled in the study,then the secretions obtained from the infection sites were cultured,the incidence of MDROs infections was analyzed,the drug susceptibility testing was performed for the MDROs strains,the result of the culture was observed,and the Logistics regression analysis was performed for the risk factors for the MDROs infections in the diabetic foot patients.RESULTS Totally 130 patients were detected positive for MDROs,with the positive rate 44.8%.A total of 159 strains of MDROs were isolated,among which the Staphylococcus aureus,Pseudomonas aeruginosa,and Escherichia coli were dominant.The drug resistance rates of the S.aureus strains to oxacillin,ampicillin-sulbactam,and cefazolin reached as high as 100.0%;the drug resistance rates of the E.coli strains to ampicillin,piperacillin-tazobactam,cefalotin,and ceftriaxone reached up to 100.0%.The multivariate logistics regression analysis indicated that the risk factors for the MDROs infections in the diabetic foot patients included the previous use of antibiotics,hospitalization frequency more than 2times per year due to same wound,complication of osteomyelitis,use of third generation cephalosporins,and neurological ischemic wounds（P〈0.05）.CONCLUSION The S.aureus is the most common in the diabetic foot patients with MDROs infections.The risk factors for the MDROs infections in the diabetic foot patients include the previous use of antibiotics,hospitalization frequency more than 2times per year due to the same wound,complication of osteomyelitis,use of third generation cephalosporins,and neurological ischemic wounds.