糖尿病足患者感染致病菌谱及其抗菌药物敏感度研究

Bacteriological spectrum and drug susceptibility of pathogens causing infection in patients with diabetic foot

目的研究糖尿病足患者感染致病菌谱及其抗菌药物敏感度。方法回顾性分析2013年1月至2016年7月于新疆医科大学第一附属医院就诊的60例糖尿病足患者的临床资料。对其分泌物进行细菌培养及抗菌药物敏感度检测，分析糖尿病足感染的致病菌谱及其对抗菌药物敏感度。并比较患者应用抗菌药物前后白细胞计数。结果60例分泌物标本细菌培养阳性者55例，阴性者5例，阳性率为91．7％（55／60）。培养出球菌者31例，占51．7％（31／60），以金黄色葡萄球菌为主；培养出杆菌者23例，占38．3％（23／60），以变形杆菌为主，其次为大肠埃希菌、铜绿假单胞菌；培养出真菌为1例，占1．7％（1／60），为白色假丝酵母菌。有2例（3．3％）检出2种细菌。金黄色葡萄球菌对青霉素敏感度明显低于对苯唑西林敏感度[9．5％（2／21）比66．7％（14／21）]，对万古霉素敏感度[100％（21／21）]明显高于对苯唑西林敏感度，差异均有统计学意义（均P〈0．05）。所有球菌对苯唑西林敏感度为71．0％（22／31），而对万古霉素敏感度为100．0％（31／31）。所有杆菌对亚胺培南／西司他丁的敏感度明显高于对头孢呋辛及氨曲南敏感度[100％（23／23）比30．4％（7／23）、43．5％（10／23）]，差异有统计学意义（P〈0．05）。患者应用抗菌药物后31例进行了血常规复查，其平均白细胞计数明显下降，由治疗前（13±6）×10^9／L降至治疗后（10±4）×10^9／L，差异有统计学意义（P〈0．05）；白细胞计数高于10×10^9／L者占比由治疗前的74．2％（23／31）降为治疗后的45．2％（14／31），差异有统计学意义（P〈0．05）。结论糖尿病足感染的病原菌中球菌占多数，根据药物敏感试验结果合理应用抗菌药物有助于感染控制。

Objective To investigate the bacteriological spectrum and drug susceptibility of pathogens causing infection in patients with diabetic foot. Methods Sixty patients with diabetic foot were enrolled from January 2013 to July 2016 in the First Affiliated Hospital of Xinjiang Medical University. Pathogens in secretions were cultivated and drug susceptibilities of pathogens were detected. Bacteriological spectrum, drug susceptibility and white blood cell count （WBC） before and after use of antibacterials were analyzed. Results Positive results of bacteria culture were detected in 55 patients （91.7 % ） ; cocci accounted for 51.7 % （31/60）, with staphylococcus aureus as a top majority; bacilli accounted for 38. 3% （23/60）, with proteus, escherichia coli and pseudomonas aeruginosa taking majorities; 1 case（ 1.7% ） of candida albicans was detected; 2 cases （3.3%） were detected as mixed infections. For staphylococcus aureus, the sensitivity to penicillin was significantly lower than that to oxacillin [9. 5% （2/21） vs 66. 7% （ 14/21 ） ] ; the sensitivity of staphylococcus aureus to vancomycin[ 100% （21/21） ] was significantly higher than the sensitivity to oxacillin（P 〈 0.05 ）. The sensitivity of cocci to oxacillin was 71.0% （22/31） and 100.0% （31/31） to vancomycin. The sensitivity of bacilli to imipenem/cilastatin was significantly higher than that to cefuroxime and aztreonam[ 100% （23/23） vs 30. 4% （7/23）, 43.5% （ 10/23 ） ] （P 〈 0. 05 ）. Only 31 cases were tested WBC after antibiotics; the average level of WBC and the radio of WBC 〉 10 ×10^9/Lafter treatment were significantly lower than those before treatment [ （ 10 ± 4） ×10^9/L vs （ 13 ±6 ） ×10^9/L, 45.2% （ 14/31 ） vs 74. 2% （23/31 ） 1 （P 〈 0. 05）. Conclusion Cocci are the dominant pathogens of infection in patients with diabetic foot.