糖尿病足疮面分泌物病原菌分布、耐药性及危险因素分析

Pathogen distribution,drug resistance and risk factors for patients with diabetic foot infection

目的:分析糖尿病足患者感染病原菌的分布、耐药性及危险因素,为指导临床合理使用抗生素,改善治疗效果提供理论依据.方法:回顾性分析2018年1月~2018年12月在我院就诊的883例糖尿病患者的临床资料和实验室数据,分析病原菌分布及耐药性,并采用单因素及多因素logistic回归分析糖尿病足感染的危险因素.结果:糖尿病足感染为332例,感染率37.6%.332例分泌物样本中共分离出344株病原菌:革兰阳性球菌115株,以金黄色葡萄球菌和表皮葡萄球菌多见;革兰阴性杆菌213株,前几种依次是铜绿假单胞菌,肺炎克雷伯菌,粘质沙雷菌和大肠埃希菌.大多数G+球菌对糖肽类抗生素、利奈唑胺、阿米卡星和替加环素均敏感,G-杆菌对阿米卡星的敏感性较高.多因素logistic回归分析显示,年龄≥60岁、糖尿病足Wagner分级≥3级、糖尿病病程≥10年、空腹血糖≥7mmol/L、糖化血红蛋白≥6.5%、尿微量白蛋白≥30mg/L是发生糖尿病足感染的独立危险因素(P<0.05).结论:临床应加强对糖尿病足感染及相关危险因素的监测,及时选择敏感抗生素,延缓病情发展,提高治愈率.

Objective:To analyze the distribution and antimicrobial susceptibility of pathogens isolated from diabetic foot patients and and to provide basis for improving the therapeutic effect in clinical practice.Methods:The clinical characteristics and laboratory data of 883 diabetic patients in our hospital from January 2018 to December 2018 were analyzed retrospectively.The distribution and antibiotic sensitivity of pathogens as well as the risk factors of diabetic foot infection were analyzed by univariate and multivariate logistic regression analysis.Results:The detection rate of foot infection in diabetic patients was 37.6%(n=332).A total of 344 bacteria were isolated from the 332 secretion samples,including 115 gram-positive cocci and 213 gram-negative bacteria.The gram positive coccus were predominated by Staphylococcus aureus and Stagphylococcus epidermidis.The major gram-negative bacteria were Pseudomonas aeruginosa,Klebsiella pneumoniae,Serratia marcescens and Escherichia coli.Most gram positive coccus were sensitive to glycopeptide antibiotics including linezolid,amikacin and tigecycline.The gram-negative bacteria had higher sensitivity to amikacin.It revealed that age older than 60,Wagner grade≥3,duration of diabetes≥10 years,fasting glucose levels≥7mmol/L,glycosylated hemoglobin≥6.5%and mic-roalbuminuria≥30mg/L were independent risk factors of diabetic foot infection by multivariate logistic regression analysis(P<0.05).Conclusion:Monitoring of diabetic foot infection should be strengthened to control the disease development and to improve the treatment effect in clinic.