2型糖尿病患者合并感染特点及病原菌分布与耐药性分析

Characteristics of combined infection and distribution of pathogens and drug resistance in patients with type 2 diabetes

目的 了解2型糖尿病(T2DM)患者感染的特点、病原菌分布及耐药性,为预防和治疗提供依据。方法 收集延安大学附属医院内分泌科2013年1月至2017年12月住院糖尿病患者资料,回顾性分析糖尿病合并感染患者特点。结果 糖尿病合并感染患者共944人,分离出致病菌302株,革兰氏阴性菌189株,革兰氏阳性菌93株,真菌20株。年龄60岁以上的占53.6%(162/302),主要感染部位包括呼吸道、泌尿道、足部等,致病菌前三位分别为大肠埃希菌、表皮葡萄球菌、金黄色葡萄球菌,革兰阴性菌中未发现耐碳青霉烯类菌株,大肠埃希菌对氨苄西林、哌拉西林耐药率较高,分别为93.2%、71.6%,对磺胺类及喹诺酮类耐药亦超过50%,革兰氏阳性菌中未发现万古霉素、利奈唑胺耐药菌株。结论 T2DM患者易合并感染,以老年糖尿病患者为主,致病菌出现高耐药率、多重耐药现象,临床应合理使用抗菌药物进行抗感染治疗。

Objective To understand the characteristics of infection,the distribution of pathogens and drug resistance in patients with type 2 diabetes mellitus (T2DM),and to provide the basis for prevention and treatment. Methods The data of hospitalized diabetic patients from January 2013 to December 2017 in the Department of Endocrinology,Affiliated Hospital of Yan'an University were collected.The characteristics of patients with diabetes mellitus were retrospectively analyzed. Results A total of 944 patients with diabetes mellitus were infected,302 strains of pathogenic bacteria,189 strains of Gram-negative bacteria,93 strains of Gram-positive bacteria and 20 strains of fungi were isolated.The age of over 60 years old accounted for 53.6%(162/302).The main infection sites included respiratory tract,urinary tract and foot.The top three pathogens were Escherichia coli,Staphylococcus epidermidis and Staphylococcus aureus.No carbapenem-resistant strains were found in Gram-negative bacteria,and Escherichia coli had higher resistance rates to ampicillin and piperacillin,which were 93.2% and 71.6%,respectively,and resistance to sulfonamides and quinolones was also more than 50%.No vancomycin or linezolid-resistant strains were found in Gram-positive bacteria. Conclusion Patients with T2DM are prone to infection,mainly in elderly patients with diabetes,and the pathogenic bacteria have high drug resistance rate and multi-drug resistance.Clinically,antibiotics should be used rationally for anti-infective treatment.