2型糖尿病足的细菌谱分布情况及其与生存状况的相关性

Distribution of bacterial spectrum and the relationship with survival in type 2 diabetic foot

目的:观察2型糖尿病足的细菌谱分布情况,探讨其与生存状况的关系。方法:选取2014年1月至2016年12月期间我院收治的194例单一细菌感染的糖尿病足溃疡(Diabetic foot ulcer,DFU)患者为研究对象,采集患者的溃疡分泌物标本,采用Mueller-HintonⅡ琼脂培养基(美国BD公司)进行细菌培养,48 h后采用PHOENIX 100型全自动微生物分析仪(美国BD公司)进行致病菌的鉴定和药敏试验,比较各个细菌感染者之间的临床资料和短期预后(出院后6个月),采用多因素logistics回归分析发生不良预后(截肢和/或死亡)的独立影响因素。结果:全部患者检出革兰阴性菌120株(61.9%)和革兰阳性菌74株(38.1%),以金黄色葡萄球菌最多见(26.8%),其次是铜绿假单胞菌(23.7%)、变形杆菌(14.4%)、屎肠球菌(11.3%)、肺炎克雷伯杆菌(9.3%)、大肠埃希菌(7.7%)和阴沟肠杆菌(6.7%)。变形杆菌、大肠埃希菌、屎肠球菌的重度感染发生率均显著高于铜绿假单胞菌(P<0.05)。各致病菌感染患者的基线资料、辅助检查结果、下肢动脉病变、周围神经病变等发生率比较,差异无统计学意义(P>0.05)。预后方面,62例(32.0%)患者出现不良预后,其中变形杆菌、大肠埃希菌、屎肠球菌的不良预后发生率均显著高于铜绿假单胞菌(P<0.05)。多因素logistic回归分析结果表明,变形杆菌、大肠埃希菌、屎肠球菌感染、重度感染、糖尿病足病程≥1个月、下肢动脉病变是患者发生不良预后的独立危险因素(P<0.05)。结论:金黄色葡萄球菌是DFU患者的常见感染菌,变形杆菌、大肠埃希菌、屎肠球菌感染更容易出现足部重度感染,短期预后更差,值得引起临床重视。

Objective:To investigate the distribution of bacterial spectrum in type 2 diabetic foot and its relationship with survival status.Methods:From January 2014 to December 2016,194 cases of diabetic foot ulcer(DFU)with single bacterial infection in our hospital were selected as the research objects.The ulcer secretion samples of patients were collected,and the bacteria were cultured with Mueller Hinton II agar medium(BD company of the United States).After 48 h,the bacteria were cultured with Phoenix 100 The clinical data and short-term prognosis(6 months after discharge)were compared among different bacterial infections.The independent influencing factors of adverse prognosis(amputation and/or death)were analyzed by multivariate logistic regression.Results:120 strains of Gram-negative bacteria(61.9%)and 74 strains of Gram-positive bacteria(38.1%)were detected in all patients.Staphylococcus aureus was the most common(26.8%),followed by Pseudomonas aeruginosa(23.7%),proteus(14.4%),Enterococcus faecium(11.3%),Klebsiella pneumoniae(9.3%),Escherichia coli(7.7%)and Enterobacter cloacae(6.7%).The incidence of severe infection of Proteus,Escherichia coli and Enterococcus faecium was significantly higher than that of Pseudomonas aeruginosa(P<0.05).There was no significant difference in baseline data,auxiliary examination results,lower extremity artery disease and peripheral neuropathy among patients with pathogenic bacteria infection(P>0.05).In terms of prognosis,62 patients(32.0%)had poor prognosis.The incidence of adverse prognosis of Proteus,Escherichia coli and Enterococcus faecium was significantly higher than that of Pseudomonas aeruginosa(P<0.05).Multivariate logistic regression analysis showed that Proteus,Escherichia coli,Enterococcus faecium infection,severe infection,diabetic foot course≥1 month,lower extremity artery disease were independent risk factors for poor prognosis(P<0.05).Conclusion:Staphylococcus aureus is a common infection bacterium in patients with DFU.Proteus,Escherichia coli and Enterococcus faecium infection are more likely to lead to severe foot infection,and the short-term prognosis is worse,which is worthy of clinical attention.