糖尿病足创面感染患者病原菌分布及耐药状况分析

Distribution and drug resistance of pathogenic bacteria isolated from infected wound of patients with diabetic foot

目的探讨糖尿病足创面感染患者的病原菌分布及耐药状况,为糖尿病足的临床治疗提供参考。方法选择2013年9月至2017年11月许昌市中心医院收治的100例糖尿病足创面感染(120处创面)患者为研究对象,采集感染部位的分泌物进行病原菌培养、分离和鉴定,对所得病原菌进行药物敏感性试验。结果 120处创面共分离出病原菌122株,其中革兰阳性菌58株(47. 5%),革兰阴性菌52株(42. 6%),真菌12株(9. 8%)。药物敏感性试验结果显示,大肠埃希菌对亚胺培南、美罗培南、头孢他啶、磷霉素、哌拉西林他唑巴坦的敏感性较高;肺炎克雷伯菌对亚胺培南、美罗培南、环丙沙星、左氧氟沙星、阿米卡星、庆大霉素、加替沙星、氨曲南的敏感性较高;铜绿假单胞菌对哌拉西林他唑巴坦、头孢吡肟、左氧氟沙星、加替沙星的敏感性较高;金黄色葡萄球菌对万古霉素、替考拉宁、美罗培南、亚胺培南、阿米卡星的敏感性较高;粪肠球菌对美罗培南、万古霉素、替考拉宁的敏感性较高;白假丝酵母菌和光滑假丝酵母菌对卡泊芬净、两性霉素B的敏感性较高。结论糖尿病足创面感染的主要致病菌为革兰阳性菌和革兰阴性菌,致病菌的耐药情况较严重,临床应根据药物敏感性试验结果,合理选择抗生素。

Objective To investigate the distribution and drug resistance of pathogenic bacteria isolated from infected wound of patients with diabetic foot,and to provide reference for clinical treatment of diabetic foot.Methods A total of 100 patients(120 wounds)with diabetic foot wound infection in Xuchang Central Hospital from September 2013 to November 2017 were selected as the research subjects.The secretions of infected position were collected for pathogenic bacteria culture,isolation and identification;and the drug sensitivity test of the pathogenic bacteria was carried out.Results A total of 122 strains of pathogenic bacteria were isolated from 120 infected wounds.Among the pathogenic bacteria,58(47.5%)strains were Gram-positive bacteria,52(42.6%)strains were Gram-negative bacteria and 12(9.8%)strains were fungi.The results of drug sensitivity test showed that the Escherichia coli was more sensitive to imipenem,meropenem,ceftazidime,fosfomycin and piperacillin tazobactam;the Klebsiella pneumoniae was more sensitive to imipenem,meropenem,ciprofloxacin,levofloxacin,amikacin,gentamicin,gatifloxacin and aztreonam;the Pseudomonas aeruginosa was more sensitive to piperacillin tazobactam,cefepime,levofloxacin and gatifloxacin;the Staphylococcus aureus was more sensitive to vancomycin,teicoplanin,meropenem,imipenem and amikacin;the Enterococcus faecalis had higher sensitivity to meropenem,vancomycin and teicoplanin;the Candida albicans and Candida tropicalis had higher sensitivity to caspofungin and amphotericin B.Conclusion The main pathogenic bacteria in infected wound of diabetic foot are Gram-positive bacteria and Gram-negative bacteria.The drug resistance of pathogenic bacteria is serious.The antibiotics should be chosen reasonably according to the results of drug sensitivity test.