糖尿病足患者合并耐甲氧西林金黄色葡萄球菌感染的临床研究

Clinical study on methicillin-resistant Staphylococcus aureus infection in patients with diabetic foot

目的探讨糖尿病足患者合并耐甲氧西林金黄色葡萄球菌感染的临床特征。方法选取2016年9月至2019年9月恩施土家族苗族自治州中心医院收治的128例糖尿病足合并金黄色葡萄球菌感染者为研究对象,对患者溃疡部位细菌进行分离、培养和鉴定,并进行药敏试验,分析病原菌的分布特征及金黄色葡萄球菌耐药情况以及相关影响因素。128例患者所分离株金黄色葡萄球菌对甲氧西林敏感者为敏感菌组(33例),对甲氧西林耐药者为耐药菌组(95例)。结果共分离出128株菌株,其中革兰阳性菌79株(61.72%)、革兰阴性菌45株(35.16%)和真菌4株(3.12%);敏感菌组和耐药菌组患者中分别分离病原菌33株和95株;敏感菌组患者分离菌株对利福平、氧氟沙星、左氧氟沙星、苯唑西林、青霉素G、头孢呋辛、阿奇霉素、头孢噻肟、呋喃妥因菌株耐药率高于耐药组,差异均有统计学意义(χ^2=7.856、12.309、19.998、15.682、4.072、30.258、6.089、22.233、5.264,P=0.004、0.001、<0.001、<0.001、0.041、<0.001、0.007、<0.001和0.018);多因素Logistic回归分析显示,低蛋白血症、溃疡面积、溃疡病程、入院前6个月使用抗菌药以及高血压均为糖尿病足患者合并耐甲氧西林金黄色葡萄球菌感染的影响因素,差异均有统计学意义(P=0.001、0.010、0.023、0.012和0.029)。结论金黄色葡萄球菌是糖尿病足疾病主要感染病原菌,低蛋白血症、溃疡面积、溃疡病程、入院前6个月使用抗菌药、高血压均为糖尿病足患者合并耐甲氧西林金黄色葡萄球菌感染的危险因素。

Objective To investigate the clinical characteristics of diabetic foot patients with methicillin-resistant Staphylococcus aureus infection.Methods Total of 128 patients with diabetic foot complicated with Staphylococcus aureus infection who were admitted to the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture from September 2016 to September 2019 were selected,and the bacteria in the ulcer site of the patients were isolated,cultured and identified,while drug susceptibility was performed.Experiment to analyze the distribution characteristics of pathogens and the drug resistance of Staphylococcus aureus and related influencing factors.Among Staphylococcus aureus isolated from 128 patients,33 cases were sensitive to methicillin(sensitive bacteria group)and 95 cases were resistant to methicillin(drug-resistant bacteria group).Results Total of 128 strains were isolated,including 79 Gram-positive bacteria(61.72%),45 Gram-negative bacteria(35.16%)and 4 fungi(3.12%).Pathogenic bacteria isolated from patients in the sensitive bacteria group and drug-resistant bacteria group were 33 strains and 95 strains,respectively.The resistance rate of the isolated strains of sensitive bacteria group to rifampicin,ofloxacin,levofloxacin,oxacillin,penicillin G,cefuroxime,azithromycin,cefotaxime and nitrofurantoin were significantly higher than those of drug-resistant bacteria group,with significant differences(χ^2=7.856,12.309,19.998,15.682,4.072,30.258,6.089,22.233,5.264,P=0.004,0.001,<0.001,<0.001,0.041,<0.001,0.007,<0.001,0.018).Multivariate Logistic analysis showed that hypoproteinemia,ulcer area,ulcer duration,use of antibiotics 6 months before admission,and hypertension were all infection influencing factors of diabetic foot patients with methicillin-resistant Staphylococcus aureus,all with significant differences(P=0.001,0.010,0.023,0.012 and 0.029).Conclusions Staphylococcus aureus is the main infectious pathogen of diabetic foot disease.Hypoproteinemia,ulcer area,ulcer course,antibacterial use 6 months before admission and hypertension were all infection relevant factors caused diabetic foot patients with methicillin-resistant Staphylococcus aureus.