糖尿病伴感染性疾病的分类、病原菌特点及影响因素

Classification, pathogen characteristics and influencing factors of diabetes mellitus with infectious diseases

目的:探讨糖尿病伴感染性疾病的分类、致病菌特点及影响因素,为临床经验性选择抗生素治疗提供依据。方法:选取377例糖尿病伴感染的住院患者为研究对象,按感染部位分为泌尿系统、非足部软组织、糖尿病足、消化系统、呼吸系统等,收集各组患者的性别、年龄、糖尿病病程、糖化血红蛋白水平、糖化白蛋白水平和病原菌培养结果,进行卡方检验和多因素Logistic回归分析。结果:(1)糖尿病伴感染性疾病中,以泌尿系统感染最多、其次依次为糖尿病足感染、呼吸系统感染、非足部的皮肤软组织感染、耳鼻喉感染、消化系统感染、生殖器感染、切口感染;(2)病原菌为革兰阴性菌占44.4%,其中大肠埃希菌占30.3%;革兰阳性菌占41.0%,其中金黄色葡萄球菌为24.7%;真菌占5.6%;(3)女性、糖化血红蛋白>9.0%、年龄>60岁的糖尿病伴感染患者多于男性、糖化血红蛋白≤9.0%、年龄≤60岁的糖尿病患者(P<0.05);糖尿病伴感染比例多集中于糖尿病病程0~20年(P<0.05);比较糖化白蛋白水平对糖尿病伴感染性疾病分布影响,差异无统计学意义(P>0.05);(4)多因素Logistic回归分析:以糖尿病足感染为参照,糖尿病病程<10年的患者合并泌尿系统、呼吸系统、非足部的软组织感染及其它部位感染的风险较糖尿病足感染的风险高;男性(OR=0.119)及糖化血红蛋白≤7%(OR=0.371)的患者患泌尿系统感染的风险低于糖尿病足感染。结论:糖尿病可能伴发各个系统的感染,感染部位不同、菌群分布不同;糖尿病病程、性别、糖化血红蛋白水平与糖尿病伴感染性疾病分类相关,经验性选择抗生素治疗感染时应充分考虑。

Objective: To investigate the types, pathogenic characteristics and influencing factors of diabetes mellitus with infectious diseases, and to provide evidence for clinical empirical selection of antibiotics. Methods: 377 patients with diabetes complicated with infection were selected as the subjects. According to the infection site, the subjects were divided into urinary system, skin and soft tissue, diabetic foot, digestive system and respiratory system. Gender, age, duration of diabetes, glycosylated hemoglobin, glycated albumin and pathogen culture were collected, and were analyzed by Chi square test and multivariate Logistic regression. Results:(1) Among diabetic patients with infectious diseases, urinary tract infection happens the most, followed by diabetic foot infection, respiratory infection, skin and soft tissue infection without foot, otorhinolaryngologic infection, digestive system infection, genital infection and wound infection.(2) Gram-negative bacteria accounted for 44.4%, Escherichia coli accounted for 30.3%, followed by gram-positive bacteria which accounted for 41.0%, and 24.7% was accounted by Staphylococcus, and fungi accounted for 5.6%.(3) Gender of women and the glycosylated hemoglobin over 9%, age exceeded 60 years old had more diabetic infection than the men and glycosylated hemoglobin below 9% or younger than 60 years old(P<0.05). The proportion of patients with diabetes complicated with infection was mainly 0-20 years of the duration of diabetes(P<0.05).(4) Multivariate Logistic regression analysis showed that with diabetic foot infection as a reference, patients with diabetes duration less than 10 years had higher risk of urinary tract infection, respiratory system soft tissue infection without foot and other site infections than those foot infection with diabetic. Men(OR=0.119) and glycosylated hemoglobin less than 7%(OR=0.371) had lower urinary tract infection risk than foot infection with diabetic. Conclusion: Diabetes may be accompanied by multiple systemic infections, with different location of infection and different flora distribution. Diabetes duration, gender and glycosylated hemoglobin level are related to type of diabetes mellitus with infectious diseases, all these factors should be fully considered when choosing antibiotic treatment empirically.