糖尿病足溃疡患者病原菌感染特征分析

Characteristic analysis of pathogenic bacteria infection in patients with diabetic foot ulcer

目的分析糖尿病足溃疡感染患者病原菌分布及对抗菌药物的耐药特点,为临床合理用药提供指导。方法回顾性分析2017年3月至2018年2月在东部战区空军医院住院治疗的157例糖尿病足溃疡感染患者的临床资料,从患者溃疡创面或深部感染灶采集脓性分泌物,进行病原菌培养、鉴定和药敏试验,统计分析病原菌构成比、耐药率及不同Wagner分级患者病原菌多药耐药率、混合菌感染率等指标。结果 157例患者共培养出病原菌197株,其中革兰阳性球菌87株(44.2%),革兰阴性杆菌104株(52.8%),真菌6株(3.0%);排位前5位病原菌分别为金黄色葡萄球菌(16.2%)、铜绿假单胞菌(13.2%)、凝固酶阴性葡萄球菌(9.6%)、奇异变形杆菌(6.1%)和肺炎克雷伯菌(5.6%)。金黄色葡萄球和凝固酶阴性葡萄球菌对青霉素、红霉素、阿奇霉素、克拉霉素耐药现象较为严重,耐药率50.0%~100%;凝固酶阴性葡萄球菌对克林霉素、左氧氟沙星、莫西沙星、庆大霉素耐药率为47.4%~63.2%;奇异变形杆菌、肺炎克雷伯菌对氨苄西林、头孢唑啉、头孢呋辛、头孢曲松、氯霉素、复方新诺明、左氧氟沙星、庆大霉素耐药较为严重,耐药率50.0%~75.0%;病原菌中革兰阴性杆菌多药耐药率显著高于革兰阳性球菌的多药耐药率(47.1%vs 25.3%,P<0.05)。Wagner 4级患者感染细菌的多药耐药率显著高于Wagner 2级患者(45.7%vs 15.0%,P<0.05);Wagner 4级患者混合菌感染率(39.7%)显著高于Wagner 2级患者(0%)和Wagner 3级患者(13.9%),差异均有统计学意义(P<0.01)。结论糖尿病足感染患者病原菌以革兰阴性菌杆菌为主,其次为革兰阳性球菌,不同病原菌耐药性差异较大。随着Wagner分级增高细菌多药耐药率和混合菌感染率趋于严重,临床应根据药敏结果,及时调整抗菌药物。

Objective To analyze the distribution of pathogenic bacteria and its resistance to antibacterial drugs in patients with diabetic foot ulcer infection,which would provide the basis for clinical drug use.Methods A total of 157 patients with diabetic foot ulcer infection hospitalized in our hospital from March 2017 to February 2018 were selected. Purulent secretions were collected from the ulcer wound surface or deep infection focus of the patients and the pathogen culture,identification and drug sensitivity test were carried out. The composition ratio of pathogenic bacteria,drug resistance rate,multi-drug resistance rate and mixed infection rate of pathogenic bacteria in patients with different Wagner grades were statistically analyzed.Results A total of 197 pathogenic bacteria were cultured from 157 patients,among which 87 were gram-positive cocci accounting for 44.2%,104 were gram-negative bacillus accounting for 52.8%,and 6 were fungi accounting for 3.0%. The top 5 pathogenic bacteria were staphylococcus aureus(16.2%),pseudomonas aeruginosa(13.2%),coagulase-negative staphylococci(9.6%),proteus strangis(6.1%)and klebsiella pneumoniae(5.6%). The resistance of Staphylococcus aureus and coagulase-negative staphylococci against penicillin, erythromycin,azithromycin and clarithromycin was more serious and the drug resistance rate was 50.0%-100%. The resistance rate of Coagulase-negative staphylococci against clindamycin,levofloxacin,moxifloxacin and gentamicin was from 47.4% to 63.2%. Proteus mirabilis and Klebsiella pneumoniae were more resistant to ampicillin,cefazolin,cefuroxime,ceftriaxone,chloramphenicol,compound sulfamethoxazole,levofloxacin and gentamicin with the resistance rate from 50.0% to 75.0%. The multidrug resistance rate of Gram-negative bacilli was significantly higher than that of Gram-positive cocci(47.1% vs 25.3%,P < 0.05). The multidrug resistance rate of Wagner grade 4 patients was significantly higher than that of Wagner grade 2 patients(45.7% vs 15.0%,P<0.05). The mixed infection rate of Wagner grade 4 patients(39.7%)was significantly higher than that of Wagner grade 2 patients(0%)and Wagner grade 3 patients(13.9%)(P <0.01).Conclusion The main pathogens of patients with diabetic foot ulcer infection,were gram-negative bacillus bacteria,followed by gram-positive coccus bacteria. The drug resistance of different pathogenic bacteria was quite different. As the Wagner classification increases,the multi-drug resistance rate and the mixed infection rate tend to be more serious. Clinical drugs should be adjusted timely according to the drug sensitivity results.