糖尿病足感染的细菌谱变迁与抗感染治疗

Changes of Bacterial Spectrum and Anti in Fection Treatment of Diabetic Foot Infection

目的探讨糖尿病足感染的细菌谱变迁情况与抗感染治疗效果。方法将自2010年1月—2014年12月在本院接受治疗的1021例糖尿病足感染患者为研究对象,对患者感染部位提取样本进行细菌检测。结果 1201例感染患者检验细菌的总阳性率为62.70%,其中革兰阴性杆菌总阳性率为38.88%,呈逐年下降趋势,主要阳性率细菌为:铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌;革兰阳性球菌总阳性率为21.40%,呈逐年上升趋势,主要细菌为金黄色葡萄球菌;总阳性率从2010年—2014年下降12个百分点;各使用药物的耐菌性为:对铜绿假单胞菌耐药性较高的分别为氨苄西林、亚胺培南、妥布霉素;对肺炎克雷伯菌耐药性较高的分别为亚胺培南、妥布霉素、头孢曲松;对大肠埃希菌耐药性较高的为亚胺培南、阿莫西林、头孢唑啉;对金黄色葡萄球菌耐药性较高的为万古霉素、亚胺培南、妥布霉素。结论糖尿病足感染的细菌谱随时间发生变化(用药情况),且在同一年段细菌的分布也会发生变化,使用药物出现的耐药性也可能出现不同程度的改变。在治疗糖尿病足感染时应先进行细菌培养,根据患者的药敏试验结果合理选用抗菌药物。

Objective to investigate the changes of bacterial spectrum and the effect of anti infection i n diabetic foot infections.Methods 1021 cases of diabetes from January 2010 to December 2014 treated i n our hospital during the period of the foot infection patients as the research object,the location of sa mples from the patients infected bacteria detection.Results 1201 cases of patients with bacterial infect ion test positive rate was 62.70%,the total positive rate of gram negative bacilli accounted for 38.88%,decreased year by year,the main positive rate of bacteria:Pseudomonas aeruginosa,Klebsiella pneumoniae,Escherichia coli;gram positive cocci total positive rate was 21.40%,increased year by year a rising tre nd,the main bacteria were Staphylococcus aureus;the total positive rate decreased 12 percentage points from 2010 to 2014; fungi resistance for the use of drugs:the high drug resistance of Pseudomonas aeruginosa we re imipenem,ampicillin,tobramycin;of antibiotic resistance of Klebsiella pneumoniae were higher imine im ipenem,ceftriaxone and tobramycin against Escherichia coli;high drug resistance to imipenem,amoxicillin and cefazolin; the drug resistance of Staphylococcus aureus to vancomycin were higher,Imipenem,tobramyci n.Conclusion diabetic foot infection bacteria spectrum change with time(medication),and the distributi on in the same period of bacteria will change,the use of drug resistance may also appear different degree s of change.Experience:in the treatment of diabetic foot infection should be the first bacterial culture,according to the patient's drug sensitivity test results reasonable choice of antimicrobial agents.