518例糖尿病足患者足部分泌物细菌谱及药敏结果分析

Analysis of bacterial spectrum and drug sensitivity of foot secretion in 518 cases of diabetes mellitus

目的了解糖尿病足(DF)患者足部分泌物的细菌谱及药敏试验结果。方法对518例DF感染患者的足部分泌物的细菌谱和药物敏感试验进行分析总结。结果518例DF患者足部分泌物中糖尿病足感染的病原菌以革兰阴性杆菌为主(59.65%),其次是革兰阳性球菌(40.35%)。而细菌种类以金黄色葡萄球菌(23.75%)、铜绿假单胞菌(14.48%)、黏质沙雷菌(10.23%)、嗜麦芽窄食单胞菌(8.11%)为主。金黄色葡萄球菌对利奈唑胺、替加环素、万古霉素、呋喃妥因和喹奴普汀-达福普汀未出现耐药现象,对苯唑西林、左氧氟沙星、红霉素、克林霉素等的敏感性较低。鲍曼复合群不动杆菌的耐药性较为严重,仅对妥布霉素具有一定的敏感性(58.21%),铜绿假单胞菌对阿米卡星(93.19%)、妥布霉素(93.45%)、庆大霉素(88.17%)、亚胺培南(88.56%)、环丙沙星(83.32%)、左氧氟沙星(82.89%)、哌拉西林+他唑巴坦(82.45%)有较高的敏感性,嗜麦芽窄食单胞菌仅对复方新诺明有较高的敏感性(100.00%)。结论DF感染的细菌谱分布广,对抗菌药物的耐药率较高,早期联合选择敏感抗菌药物治疗是DF感染治疗的关键。

Objective To understand the bacterial spectrum and drug sensitivity test results of foot secretion in patients with diabetic foot(DF).Methods The bacterial spectrum and drug sensitivity test results of 518 patients with DF infection were analyzed.Results The main pathogen of diabetic foot infection in foot secretions of 518 DF patients was Gram-negative bacilli(59.65%),followed by Gram-positive cocci(40.35%).However,Staphylococcus aureus(23.75%),Pseudomonas aeruginosa(14.48%),Serratia marcescens(10.23%),and Narrow maltophilia(8.11%)were the predominant bacterial species.Staphylococcus aureus showed no resistance to rizamide,teicycline,vancomycin,nitrofurantoin and quinolaprin-dalfopristin,and had low sensitivity to oxacillin,levofloxacin,erythromycin,and clindamycin.The resistance of P.baumannii complex was more serious,with only some sensitivity to toobramycin(58.21%),P.aeruginosa had high sensitivity to amikacin(93.19%),toobramycin(93.45%),gentamicin(88.17%),imipenem(88.56%),ciprofloxacin(83.32%),levofloxacin(82.89%),and piperacillin+tazobactam(82.45%),and P.maltophilia had only high sensitivity to cotrimoxazole(100.00%).Conclusion The bacteria spectrum of DF infection is wide,and the resistance rate to antibiotics is high.Early combined selection of sensitive antibiotics is the key to the treatment of DF infection.