少见细菌感染对糖尿病足溃疡患者病情和预后的影响

Impact of rare bacterial infections on clinical outcome in patients with diabetic foot ulcer

目的观察少见细菌感染对糖尿病足溃疡(DFU)患者病情及预后的影响。方法选取单一感染中常见及相对少见的15个菌种共计288例DFU患者,进行入组病情分析、随访近远期预后指标。根据愈合、截肢、心脑血管事件、死亡等病情结局,分析各组间差别与不同结局的相关危险因素。结果少见感染菌种为鲍曼不动杆菌、表皮葡萄球菌、摩根摩根菌、溶血葡萄球菌、停乳链球菌、无乳链球菌、阴沟肠杆菌、粘质沙雷菌;各组间患者年龄、白蛋白、HbA1C、体重指数、足溃疡病情、感染程度、愈合及小截肢存在显著差异。严重下肢动脉病变、年龄>70岁是愈合的主要危险因素;Wagner 3级及以上、停乳链球菌感染是小截肢的主要危险因素;严重下肢动脉病变、血红蛋白≤90 g/L、血白蛋白≤30 g/L是大截肢的主要危险因素;估算的肾小球滤过率(eGFR)<60 ml·min^(-1)·(1.73 m^(2))^(-1)、血红蛋白≤90 g/L是心衰的主要危险因素;年龄>70岁、血白蛋白≤30 g/L是死亡的主要危险因素(均P<0.05)。结论少见的不同细菌感染的DFU患者整体病情、足溃疡病情、感染程度及预后有差别。

Objective To analyze the impact of rare bacteria infection on clinical outcome in patients with diabetic foot ulcer(DFU).Methods A total of 288 cases infected with single strains bacteria were selected.Data were grouped according to the 15 bacteria infection identified.The outcomes of healing,amputation,cardio and cerebrovascular events,and death were collected,and risk factors to the outcome were analyzed.Results The rare infected bacteria were acinetobacter baumannii,staphylococcus epidermidis,morgan morganella,staphylococcus haemolyticus,streptococcus lactis,streptococcus agalactiae,enterobacter cloacae,and serratia marcescens.There were significant differences in age,albumin,HbA1C,body mass index,condition of foot ulcer,degree of infection,healing,and minor amputation among these groups.Severe lower extremity arterial disease and age over 70 years were the main risk factors for the healing of ulcers.Wagner grade over 3 and infected with streptococcus lactis were the main risk factors for minor amputation.Severe lower extremity arterial disease,hemoglobin(Hb)≤90 g/L,and albumin(ALB)≤30 g/L were the main risk factors for major amputation.Estimated glomerular filtration rate<60 ml·min^(-1)·(1.73 m^(2))^(-1) and Hb≤90 g/L were the main risk factors for heart failure.Age over 70 years and ALB≤30 g/L were the main risk factors for death(All P<0.05).Conclusion There exist significant differences in general condition,foot ulcer,and outcome in DFU patients infected with rare bacteria strains.