糖尿病足合并感染患者病原菌分布及耐药性变迁

Trend in Distribution and Antibacterial Resistance of Pathogens in Diabetic Foot Complicated with Infection

目的分析糖尿病足溃面处病原菌分布及耐药性变迁,为临床合理使用抗菌药物提供依据。方法回顾性分析2014~2016年在某院住院的93例糖尿病足感染患者分泌物中分离的99株病原菌及3年耐药性的变迁。结果糖尿病足患者感染的病原体中,细菌感染占95.9%,真菌占4.1%。细菌性病原菌中,革兰氏阳性菌感染占31.3%,以葡萄球菌多见,但耐甲氧西林金黄色葡萄球菌(MRSA)及耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的发生率逐年下降,未见对万古霉素耐药的革兰氏阳性球菌;革兰氏阴性菌占64.6%,且占比逐渐上升,分布以肠杆菌科细菌为主,其次为铜绿假单胞菌,对常用抗菌药物耐药率逐年升高;真菌感染以混合感染形式出现,呈逐年下降趋势。结论对糖尿病足感染病原菌及其耐药性进行监测,可为防治糖尿病足感染提供用药依据,合理使用抗菌药物。

OBJECTIVE To analyze the trend in distribution and antibacterial resistance of pathogens in the diabetic foot ulcers and to provide the basis for clinical treatment and rational use of antibiotics. METHODS Retrospective analysis of 99 pathogenic bacteria isolated from secretions of 93 diabetic foot patients from 2014 to 2016 in the hospital and the transition of drug resistance over the past 3 years were carried out. RESULTS Among the diabetic foot infections,bacterial infection accounted for 95. 9%,fungi accounted for 4.1%. G＋bacteria accounted for 31. 3%,with a majority of grape cocci,but methicillin resistant Staphylococcus aureus（ MRSA） and methicillin resistant coagulase negative staphylococcus（ MRCNS） incidence decreased year by year,with no G＋cocci that were resistant to vancomycin; G-bacteria accounted for 64. 6%,and the proportion gradually increased,dominated by Enterobacteriaceae,followed by Pseudomonas aeruginosa,resistant to common antibiotics increased year by year. Fungal infection appeared in the form of mixed infection,which showed a decreasing trend year by year. CONCLUSION Monitoring of pathogens and drug resistance of diabetic infection is beneficial to the prevention and treatment of diabetic foot infection,and provide the basis for drug use,and to promote rational use of antibiotics.