老年糖尿病足溃疡患者两种及以上多重耐药菌混合感染的特征及影响因素分析

Characteristics and influencing factors of mixed infection of two or more multidrug-resistant bacteria in elderly patients with diabetic foot ulcers

目的探讨糖尿病足溃疡(DFU)老年患者两种及以上多重耐药菌(MDRO)混合感染的影响因素。方法收集2011年2月至2020年12月贵州医科大学第三附属医院与黔南州人民医院收治的老年DFU患者。记录患者的临床资料、创面分泌物的病原菌培养与菌种鉴定结果以及两种及以上MDRO混合感染类型。根据分离培养创面分泌物检出的MDRO种数分为两种及以上MDRO感染、单种MDRO感染与非MDRO感染组,采用χ^(2)检验、单因素方差分析或Kruskal-Wallis H检验进行组间比较。对老年DFU患者发生两种及以上MDRO混合感染相关因素进行多因素logistic回归分析。结果945例老年DFU患者纳入研究,其中两种及以上MDRO混合感染率为11.01%(104/945)。非MDRO感染组、单种MDRO感染组和两种及以上MDRO感染组患者分别为652、189和104例,3组患者间合并骨髓炎、住院次数、住院时间、入住重症监护室(ICU)时间、血糖、糖化血红蛋白、联用抗菌药物种数、更换抗菌药物种数、换药次数、慢性肾脏病(CKD)、周围动脉病变(PAD)、糖尿病周围神经病变(DPN)、手术病灶清除情况差异有统计学意义(P<0.05)。更换抗菌药物种数、糖化血红蛋白、联用抗菌药物种数、入住ICU时间、PAD、DPN是老年DFU患者两种及以上MDRO混合感染的独立危险因素;换药次数、手术病灶清除次数是老年DFU患者两种及以上MDRO混合感染的独立保护因素。结论控制PAD与DPN的发生,减少入住ICU时间,持续控制血糖,避免频繁更换抗菌药物,加强换药,及时清除病灶可减少老年DFU患者两种及以上MDRO混合感染的风险。

Objective To investigate the influencing factors of mixed infection of two or more multidrug-resistant bacteria(MDRO)in elderly patients with diabetic foot ulcers(DFU).Methods The elderly patients with DFU in Third Affiliated Hospital of Guizhou Medical University and Qiannan People′s Hospital from February 2011 to December 2020 were recruited.The clinical data of the patients,the results of pathogen culture and strain identification of wound secretion,and two or more types of MDRO mixed infection were recorded.According to the number of MDRO species detected in wound secretion,they were divided into two or more MDRO infection group single MDRO infection group and non MDRO infection group,thenχ^(2) test,one-way analysis of variance(ANOVA)or Kruskal Wallis H test was used for comparisons among the three groups.Multivariate logistic regression analysis was performed on the related factors of mixed infection of two or more MDRO in eldly patients with DFU.Results Total 945 elderly patients with DFU were included in the study.In 945 elderly patients with DFU,the mixed infection rate of two or more MDRO was 11.01%(104/945).There were 652,189 and 104 patients in non MDRO infection group,single MDRO infection group and two or more MDRO infection group,respectively.There were statistically significant differences in combined osteomyelitis,number of hospitalization,length of stay,admission to intensive care unit(ICU)time,blood sugar,glycosylated hemoglobin,the number of combined antibiotics,replacement of antibiotics,number of dressing change,diabetic chronic kidney disease(CKD),peripheral artery disease(PAD),diabetic peripheral neuropathy(DPN)among the three groups(P<0.05).The independent risk factors of two or more MDRO mixed infection in elderly DFU patients were the number of antibiotics changed,glycosylated hemoglobin,combined antibiotics,ICU stay,PAD and DPN.The times of dressing change and surgical focus clearance were independent protective factors for two or more MDRO mixed infections in elderly patients with DFU.Conclusions Controlling the occurrence of PAD and DPN,reducing ICU stay time,continuous control of blood glucose,avoiding frequent change of antibiotics,strengthening dressing change,and timely removal of lesions can reduce the risk of two or more MDRO mixed infection in elderly DFU patients.