2型糖尿病合并社区感染败血症临床特点分析

Analysis on clinical features of septicemia caused by community infection in type 2 diabetes mellitus

目的对2型糖尿病合并社区感染败血症的临床特点进行回顾性分析,以便为2型糖尿病合并社区感染败血症的治疗提供理论依据。方法收集2017年1月~2019年12月于我院住院的社区感染败血症患者共69例,其中2型糖尿病组25例,无糖尿病组44例,分析两组临床资料、原发感染灶、耐药率及病原菌种类等指标。结果2型糖尿病组空腹静脉血糖(FPG)、糖化血红蛋白(HbA1c)、糖尿病病程与无糖尿病组比较明显增大(P<0.05);两组间性别、年龄、体重指数(BMI)、住院时间、住院费用、降钙素原(PCT)、血肌酐、超敏C反应蛋白(hs-CRP)、白细胞、中性粒细胞百分比(Neu%)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、白蛋白比较,差异无统计学意义(P>0.05)。原发感染灶多位于泌尿道(40.6%),其次肺部感染较多(34.8%),胆道感染、肝脓肿、骨髓炎、感染性心内膜炎、皮肤蜂窝织炎、产褥感染发生率(1.4%)相似,两组间原发感染灶比较,差异无统计学意义(P>0.05)。2型糖尿病组病原菌耐药率(56.0%)明显高于无糖尿病组(25.0%),差异有统计学意义(χ2=6.631,P<0.05)。2型糖尿病组革兰阴性菌与真菌感染率明显高于无糖尿病组,无糖尿病组革兰阳性菌感染率高于2型糖尿病组(P<0.05)。结论2型糖尿病合并社区感染败血症患者更易对抗菌药物耐药,2型糖尿病人群革兰阴性菌与真菌感染率明显高于无糖尿病人群,治疗时需有针对性选用敏感抗菌药物,适当延长抗感染治疗时间。

Objective To retrospectively analyze the clinical features of type 2 diabetes mellitus(T2DM)complicated with community infected septicemia,so as to provide theoretical basis for the treatment of T2DM complicated with community infected septicemia.Methods A total of 69 community infected septicemia patients admitted to our hospital from January 2017 to December 2019 were collected,in which 25 patients with T2DM(the T2DM group)and 44 patients without diabetes mellitus(non-diabetes group)were included.The indexes of clinical data,primary infection focus,drug resistance rate and pathogen types of the two groups were analyzed.Results Compared with the non-diabetes group,FPG,HbA1c and diabetes course in the T2DM group increased significantly(P<0.05).Gender,age,BMI,hospital stay,hospitalization expenses,PCT,serum creatinine,hs-CRP,white blood cells,Neu%,ALT,AST and albumin had no statistically significant differences between the two groups(P>0.05).The primary infections was located in urinary tract(40.6%),followed by pulmonary infections(34.8%).The incidences of biliary tract infection,hepatic abscess,osteomyelitis,infective endocarditis,skin cellulitis and puerperal infection(1.4%)was similar,but there was no significant difference between the two groups(P>0.05).The drug resistance rate of pathogenic bacteria(56.0%)in the T2DM group was higher than that in the non-diabetes group(25.0%)(χ2=6.631,P<0.05).The infection rate of Gram-negative bacteria and fungi in the T2DM group was significantly higher than that in the non-diabetes group,and the infection rate of Grampositive bacteria in non-diabetes group was higher than that in the T2DM group(P<0.05).Conclusion Patients with T2DM complicated with community infected septicemia are more likely to be resistant to antibiotics.The infection rate of Gram-negative bacteria and fungi in the T2DM people is significantly higher than that in the non-diabetes people.Sensitive antibiotics should be targeted,and the anti-infection treatment time should be prolonged appropriately.