糖尿病足感染181例临床分析

Clinical analysis of 181 cases of diabetic foot infection

目的研究糖尿病足感染临床特征、临床分离菌分布和药敏结果,为临床诊治提供参考。方法回顾181例糖尿病足感染患者诊治过程,采集临床特征(感染深度、血供情况、坏疽、起病原因)、临床分离菌群及药敏结果,并进行分析。结果①181例糖尿病足感染患者中,86例感染累及浅中层组织,95例感染累及深层组织;155例无或轻度缺血,26例重度缺血;116例无坏疽,65例有坏疽;起病原因主要是自发破溃(69例)和外伤(82例)。②共分离出278株细菌,其中革兰阳性菌163株(58.6%),革兰阴性菌115株(41.4%);118例(65.2%)为单一菌感染(118株),63例(34.8%)为复数菌感染(160株);主要分离菌为金黄色葡萄球菌(85株,30.6%)、凝固酶阴性葡萄球菌(11株,4.0%)、链球菌(37株,13.3%)、肠球菌(20株,7.2%)、铜绿假单胞菌(26株,9.4%)和肠杆菌科细菌(60株,21.6%)。③浅中层感染以金黄色葡萄球菌等革兰阳性菌多见,而深层感染时肠杆菌科细菌等革兰阴性菌比例明显较高;无或轻度缺血时金黄色葡萄球菌、链球菌等革兰阳性菌比例较高,而重度缺血时肠杆菌科细菌、铜绿假单胞菌等革兰阴性菌比例较高,重度缺血时复数菌比例较高;无坏疽时金黄色葡萄球菌等革兰阳性菌比例较高,而坏疽时肠杆菌科细菌等革兰阴性菌比例较高,有坏疽时复数菌比例较高。结论不同糖尿病足感染临床特征、临床分离菌群有各自特点,临床特征与菌群存在相关性,临床实践中需根据不同糖尿病足感染病情选择合适的抗菌药物。

Objective To provide evidence for clinical diagnosis and treatment through study on the correlation between clinical characteristics and microbiological pathogens(including susceptibility profile)of diabetic foot infection(DFI).Methods A total of 181 patients with DFI were reviewed for the clinical management.The clinical characteristics(infection depth,blood supply,gangrene,cause),bacterial isolates,and susceptibility testing were collected and analyzed.Results Among the 181 cases of DFI,86 were superficial or medium-depth,95 were deep infection.The DFI was associated with severe ischemia in 26 cases,but mild ischemia or no ischemia in 155 cases.The DFI was associated with gangrene in 65 cases,but without gangrene in 116 cases.The trigger of DFI was spontaneous rupture in 69 cases and trauma in 82 cases.Of the 278 bacterial strains isolated from patients,163(58.6%)were gram-positive bacteria,and 115(41.4%)were gram-negative bacteria.Single pathogen was isolated in 118 patients(118 strains),and multiple pathogens were isolated in 63 patients(160 strains).The pathogenic bacteria included Staphylococcus aureus(85 strains,30.6%),Enterobacteriaceae(60 strains,21.6%),Streptococcus(37 strains,13.3%),Pseudomonas aeruginosa(26 strains,9.4%),Enterococcus(20 strains,7.2%),and coagulase-negative Staphylococcus(11 strains,4.0%).The main bacteria isolated from superficial and medium-depth infection were S.aureus,while the prevalence of Enterobacteriaceae increased significantly in deep infection.S.aureus and Streptococcus infections was identified in higher percentage of patients without ischemia or with mild ischemia,while Enterobacteriaceae and P.aeruginosa infections were found in higher percentage of patients with severe ischemia.Mixed infection due to multiple bacteria was found in higher percentage of patients with severe ischemia.S.aureus was more likely isolated from patients without gangrene while Enterobacteriaceae was more likely isolated from patients with gangrene.Gangrene was associated with mixed infection due to multiple bacteria.Conclusions DFI had different clinical characteristics and clinical pathogens.Clinical characteristics were correlated with bacterial pathogens.In clinical practice.It is necessary to prescribe appropriate antibiotics according to DFI features.