糖尿病足溃疡面病原菌与影响因素分析

Analysis of pathogenic bacteria and influencing factors of diabetic foot ulcer surface

目的探讨我院住院糖尿病足患者溃疡面病原菌的特点及合并多重耐药菌株(multidrug resistant bacteria,MDR)感染的危险因素。方法对2003-2017年在我院收治的241例糖尿病足患者的资料进行总结,分析其细菌谱、药敏特点及影响因素。结果本研究共培养病原菌241株,其中革兰阳性菌143株(59.3%),革兰阴性菌89株(36.9%),真菌9株(3.8%)。而MDR共82株。Logistic回归分析发现,HbA1c[优势比(OR)=2.104,95%CI:1.720~2.574]、SCr水平(OR=1.007,95%CI:1.000~1.014)、病程≥10年(OR=4.148,95%CI:1.731~9.938)、Wagner分级≥3级(OR=2.947,95%CI:1.188~7.313)、骨髓炎(OR=3.867,95%CI:1.382~10.822)是MDR感染的独立危险因素。结论糖尿病足溃疡面感染的病原菌以革兰氏阳性菌为主,临床上糖尿病足合并MDR感染溃疡愈合时间长,并与血糖情况、肾功能情况、糖尿病病程、Wanger分级密切相关,入院后应尽早进行药敏试验,合理选择抗菌素。

Objective To investigate the characteristics of ulcerative pathogens in diabetic foot patients and the risk factors of multiple drug-resistant strains(MDR)infection. Methods The data of 241 patients with infected diabetic foot ulcer in our hospital from 2003 to 2017 were summarized. The bacterial spectrum,susceptibility characteristics and influencing factors were analyzed. Results A total of 241 pathogens were cultured in this study,including 143 strains of Gram-positive bacteria(59.3%),89 strains of Gram-negative bacteria(36.9%),and 9 strains of fungi(3.8%). A total of 82 strains of multidrug resistance(MDR)bacteria were cultured in this study. Logistic regression analysis found that HbA1 c[odds ratio(OR)= 2.104,95% CI:1.720 ~ 2.574],SCr level(OR = 1.007,95% CI:1.000 ~ 1.014),disease duration ≥ 10 years(OR = 4.148),95% CI:1.731 ~ 9.938),Wagner grade ≥ 3(OR = 2.947,95% CI:1.188 ~ 7.313),with osteomyelitis(OR = 3.867,95% CI:1.382 ~10.822)arerespectively independent risk factors for MDR infection. Conclusion The pathogen of diabetic foot ulcer infection is mainly Gram-positive bacteria. Diabetic foot combined with MDR infection has a long healing time and is closely related to blood glucose,renal function,diabetes duration,and Wanger classification. After admission,drug sensitivity test should be carried out as soon as possible and antibiotics should be reasonably selected.