糖尿病足溃疡患者感染铜绿假单胞菌的相关因素及药敏分析

Related Factors and Drug Sensitivity Analysis of Pseudomonas Aeruginosa Infection in Patients with Diabetic Foot Ulcer

目的探究糖尿病足溃疡(DFU)患者感染铜绿假单胞菌(PA)的相关因素并分析其药物敏感性。方法回顾性分析本院2017年3月至2020年3月125例确诊为DFU患者的临床资料,按照有无感染PA分为PA组(67例)和非PA组(58例),采用单因素和多因素Logistic回归分析影响其感染PA的相关因素,并分析PA对常见抗菌药物的耐药性。结果①PA组患者周围神经病变、周围血管病变、骨髓炎及入院前因同一溃疡住院史的比例均高于非PA组患者,两组患者感染程度与Wagner分级比例差异均有统计学意义(P均<0.05);②Logistic回归结果显示,入院前因同一溃疡住院史、Wagner分级均为DFU患者感染PA的独立性危险因素(P均<0.05);③PA的耐药性研究显示,其对头孢他啶(88.06%)、头孢吡肟(86.57%)、哌拉西林/他唑巴坦(86.57%)、环丙沙星(82.09%)和美罗培南(80.60%)的耐药率均>80%;对哌拉西林(76.12%)、阿米卡星(74.63%)、庆大霉素(71.64%)、亚胺培南(71.64%)、妥布霉素(70.15%)耐药率为70.00%~80.00%;对氨曲南、左氧氟沙星耐药率较低,为68.66%与62.69%。结论PA对抗菌药物存在不同程度的耐药性,临床需根据实际药敏情况选用恰当的抗菌药物进行治疗;入院前存在因同一溃疡住院史与Wagner分级级别高是影响DFU患者感染PA的独立危险因素。

Objective To explore the related factors of patients with diabetic foot ulcers(DFU)infected with pseudomonas aeruginosa(PA)and analyze their drug sensitivity.Methods A retrospective analysis of the clinical data of 125 patients diagnosed with DFU in our hospital from March 2017 to March 2020 and they were divided into PA group(67 cases)and non-PA group(58 cases)according to their presence or absence of PA.The two groups Clinical data were compared,single and multivariate Logistic regression was used to study the risk factors of PA infection,and the resistance of PA to common antibacterial drugs was analyzed.Results①The proportions of peripheral neuropathy,peripheral vascular disease,osteomyelitis,and hospitalization history due to the same ulcer before admission in the PA group were higher than those in the non-PA group.The difference in the infection degree and the Wagner classification ratio between the two groups was statistically significant(P all<0.05).②Logistic regression results showed that the hospitalization history and Wagner classification of the same ulcer before admission were independent risk factors for PA infection in DFU patients(P all<0.05).③The resistance study of PA showed that it was resistant to ceftazidime(88.06%).The resistance rate of cefepime(86.57%),piperacillin/tazobactam(86.57%),ciprofloxacin(82.09%)and meropenem(80.60%)was>80%;to piperacillin(76.12%),amikacin(74.63%),gentamicin(71.64%),imipenem(71.64%),tobramycin(70.15%),the resistance rate were between 70.00%and 80.00%.The resistance rates of aztreonam and levofloxacin were low,68.66%and 62.69%.Conclusion PA has different degrees of resistance to antibacterial drugs.In the future,the clinic needs to select appropriate antibacterial drugs for treatment according to the actual drug sensitivity.The hospitalization history of the same ulcer and the high Wagner grade before admission are independent risks of PA infection in DFU patients Factors.