糖尿病足溃疡患者耐药大肠埃希菌感染的临床特点与相关危险因素分析

Clinical characteristics and related risk factors of diabetic foot ulcer with Escherichia coli infection

目的分析糖尿病足溃疡（DFU）患者中大肠埃希菌感染的临床特点，探讨耐药菌株的分布情况及相关危险因素。方法选取758例DFU合并感染患者的足部分泌物进行常规细菌培养，分析耐药大肠埃希菌感染患者的临床特点、药敏情况及耐药危险因素。结果细菌培养阳性的标本中共培养出82株大肠埃希菌，其中耐药菌有37株，占大肠埃希菌感染的45．1％。耐药菌感染患者病情重、预后差，1年溃疡愈合率为69．2％。耐药大肠埃希菌对亚胺培南、美罗培南、哌拉西林／他唑巴坦和头孢西丁敏感性高。Logistic回归分析结果显示，糖化血红蛋白（HbAlc）和抗生素用药史是大肠埃希菌耐药的危险因素（OR=11．191、16．104，P〈0．05）。结论耐药大肠埃希菌感染的DFU患者预后较差，早期诊断、及时进行病原学检测和合理使用抗生素有助于减少不良预后以及耐药菌的产生。

Objective To analyze the clinical characteristics and related risk factors of diabetic foot ulcers（DFU） with drug-resistant Escherichia coli（ E. coli） infection as well as explore the distribution of drug-resistant E. coli strains. Methods Pretreatment specimens of foot secretion were obtained from 758 patients with DFU and sent for pathogen culture. The clinical characteristics, antibiotic susceptibility and risk factors of drug-resistant E. coli infection were analyzed. Results Among the strains of pathogens,82 cases turned out to be E. coli of which 31 strains （45.1% ） were the drug-resistant E. coli. The patients infected with drug-resistant E. coli had worse prognosis compared with non-drug resistant group and 69.2% of ulcer were cured within one year. The drug-resistant E. coli were highly sensitive to imipenem, meropenem, piperacillin/sulbactam and cefoxitin. The Logistic regression analysis revealed that glycosylated hemoglobin（HbAlc） and history of antibiotic medication were the independent risk factors of infections with the drug-resistant E. coli （ OR = 11. 19=1,16. 104, P 〈 0. 05 ）. Conclusion Worse conditions were observed in the DFU patients infected with drug-resistant E. coli and drug-resistant E. coli also indicated poor prognosis. Early diagnosis, timely etiology detection and reasonable use of antibiotics can help reduce the Moor nroanosis and defer the generation of drug-resistant bacteriA_