糖尿病足患者足分泌物分离菌分布及多重耐药影响因素分析

An analysis of the distribution of pathogenic bacteria in patients with diabetic foot and factors related to drug resistance

目的探讨糖尿病足患者足分泌物的分离菌种类、耐药情况及耐药影响因素,为临床防治提供参考。方法收集2016年1月—2016年12月到我院内分泌科确诊为糖尿病足溃疡的患者,共119例。对患者分泌物病原菌及药敏结果进行分析,同时收集患者年龄、身体质量指数(BMI)、糖尿病病程(糖尿病/年)、足溃疡病程(足溃疡/d)、餐前血糖、糖化血红蛋白(HbA1c)、维生素D水平,分别与病原菌耐药性进行单因素和多因素分析。结果 119例糖尿病足溃疡的患者共培养出细菌107株,以金黄色葡萄球菌、铜绿假单胞菌、奇异变形菌为主要感染菌,其中检出多重耐药菌(MDROs)28株(占阳性检出率26.17%)。MDROs感染危险因素的单因素和多因素分析表明,年龄≥65岁、维生素D水平在20~30ng/mL、足溃疡病程≥60d,是MDROS感染的独立危险因素。结论糖尿病足感染主要以金黄色葡萄球菌为主,最常见的多重耐药菌株也为金黄色葡萄球菌,影响耐药的因素有年龄、维生素D水平和足溃疡病程。

Objective To analyze the distribution of pathogenic bacteria causing foot infection in patients with diabetic foot and factors related to drug resistance in order to provide scientific guidance to control infections. Methods Collected samples from the 119 patients who were diagnosed as diabetic foot in our hospital from January 2016 to December 2016. Analyzed the pathogens from the discharge of the selected patients （excluding repeated strains） and drug sensitivity, collected the patients＇ age, body mass index （BMI）, diabetes duration （DM/year）, foot ulcer duration （ulcer/day）, fasting blood glucose, glycosylated hemoglobin （HbAlc）, the level of vitamin D and analyzed their relations with the drug resistance. Results Among the 119 patients with diabetic foot ulcers, 79 were males and 40 were females. In total, 107 strains of pathogenic bacteria were isolated from 89 patients （74.79%）. The main bacteria were Staphylococcus aureus, Pseudomonas aeruginosa and Proteus mirabilis. 28 strains were multi-drug resistant organisms （MDROs） （accounted for 26.17% of the positive rate）. The single factor analysis of the risk factors of MDROs infection showed that 65 years of age or older, the level of vitamin D between 20 and 30ng/mL and foot ulcer duration more than 60 days were the independent risk factors of MDROs infections. Conclusion Staphylococcus aureus is the main bacteria of diabetic foot infection and the most common multi-drug resistant bacteria is also Staphylococcus aureus. The risk factors that influence the drug resistance include the age of patients, the vitamin D level, and the duration of foot ulcer.