糖尿病足患者多药耐药菌感染的危险因素及耐药性分析

Risk factors and drug resistance of multiple-drug resistant bacteria infection in patients with diabetic foot

目的探讨糖尿病足患者多药耐药菌感染的危险因素、病原学和耐药性,为临床防治糖尿病足提供依据。方法自2014年1月-2016年1月前瞻性收集医院收治的糖尿病足患者121例,其中多药耐药菌感染患者45例,非多药耐药菌感染的患者76例;分析多药耐药菌感染的糖尿病足患者临床特征、危险因素、病原学和耐药性。结果糖尿病足患者多药耐药菌感染率为37.19%;单因素和多因素回归分析显示,溃疡病程、抗菌药物使用时间、Wagner分级和骨髓炎是糖尿病足患者多药耐药菌感染的危险因素(P<0.05);共培养出多药耐药菌76株,以革兰阴性菌为主,共44株占57.89%;革兰阴性菌对头孢替担和磺胺甲噁唑/甲氧苄啶耐药率为100.00%,对头孢唑肟、亚胺培南和左氧氟沙星耐药率较低,均<16.00%。结论糖尿病足患者多药耐药菌感染发生率较高,以革兰阴性菌为主,对多数抗菌药物耐药,溃疡病程、抗菌药物使用时间、Wagner分级和骨髓炎是糖尿病足患者多药耐药菌感染的危险因素。

OBJECTIVE To investigate the risk factors, etiology and drug resistance of multiple--drug resistant bacteria infection in patients with diabetic foot, so as to provide basis for clinical prevention and treatment of dia- betic foot. METHODS From Jan. 2014 to Jan. 2016, 121 cases of diabetic foot patients in our hospital were pro- speetively collected, including 45 cases with multiple-drug resistant bacteria infection and 76 cases without multi- ple-drug resistant bacteria infection. The clinical features, risk factors, etiology and drug resistance of multiple- drug resistant bacteria infection in diabetic foot patients were analyzed. RESULTS The infection rate of multiple- drug resistant bacteria was 37.19% （45/121） in diabetic foot patients. Univariate and multivariate regression a- nalysis showed that the duration of ulcer, usage time of antibiotics, classification of Wagner and osteomyelitis were risk factors for multiple-drug resistant bacterial infection in patients with diabetic foot （P〈0. 05）. Seventy-six strains of multiple-drug resistant bacteria were cultured, which were mainly 44 strains of gram-negative bacteria, accounting for 57.89 %. The resistant rates of gram-negative bacteria to cephalosporin and sulfamethoxazole/trim- ethoprim were as high as 100.00%, and to eeftizoxime, imipenem and levofloxacin were all less than 16.00% . CONCLUSION There is a high incidence of multiple-drug resistant bacteria infection in patients with diabetic foot. Most of them are gram-negative bacteria and they are resistant to most antibiotics. Duration of ulcer, usage time of antibiotics, classification of Wagner and osteomyelitis are risk factors for multiple-drug resistant bacterial infection in patients with diabetic foot.