糖尿病足多重耐药菌感染的分布及耐药性的危险因素分析

The distribution of multi-drug resistant bacteria infection and analysis of risk factors of drug resistance in patientswith diabetic foot

目的探讨糖尿病足患者多重耐药菌(multi-drug resistant organisms,MDROs)的分布及耐药性的危险因素。方法回顾性分析2017年1月至2020年11月糖尿病足感染且分泌物阳性的69例患者的临床资料。对患者足部分泌物进行病原菌及药敏分析,分析患者临床资料、MDROs分布情况及耐药性的危险因素。结果糖尿病足感染患者分泌物培养阳性69例,其中MDROs组39例(56.52%),敏感菌组30例(43.48%);MDROs组共分离出39株,前4位的细菌依次为金黄色葡萄球菌、肠杆菌科、铜绿假单胞菌、表皮葡萄球菌,分别占比46.15%、30.77%、7.69%、7.69%;MDROs感染的危险因素分析显示,既往抗菌药物暴露史、同一溃疡面住院>2次/年、神经缺血性伤口、高胆固醇血症是MDROs感染的独立危险因素(P<0.05)。结论糖尿病足患者MDROs感染主要以金黄色葡萄球菌、肠杆菌科为主,影响耐药性的危险因素有高胆固醇、既往抗菌药物暴露史、同一溃疡面住院>2次/年、神经缺血性伤口。

Objective To investigate the distribution of multi-drug resistant organisms(MDROs)and risk factors of drug resistance in patients with diabetic foot.Methods A retrospective analysis of clinical data of 69 patients with diabetic foot infection and positive secretions from January 2017 to November 2020 was performed.The pathogenic bacteria of the patient's foot secretions and the drug susceptibility were evaluated.The patient's clinical data,the distribution of MDROs and the risk factors for drug resistance were analyzed.Results There were 69 diabetic foot infections with positive secretion culture.In the 69 patients,there were 39(56.52%)in the MDROs group and 30(43.48%)in the sensitive bacteria group.In the MDROs group,39 strains were isolated,in which the top 4 bacteria were Staphylococcus aureus,Enterobacteriaceae,Pseudomonas aeruginosa and Staphylococcus epidermidis,accounting for 46.15%,30.77%,7.69%and 7.69%,respectively.Single-factor and multi-factor analysis of risk factors for MDROs infection showed that previous antimicrobial exposure history,the same ulcer face hospitalizations>2 times/year,neuroischemic wounds and high cholesterol were independent risk factors for MDROs infection(P<0.05).Conclusion In diabetic foot patients,when MDROs infection occurs,Staphylococcus aureus and Enterobacteriaceaeare the main infection bacteria.The risk factors affecting drug resistance include high cholesterol,past history of antimicrobial exposure,hospitalizations on the same ulcer surface>2 times/year,and neuroischemic wounds.