糖尿病酮症酸中毒伴感染者病原菌耐药特点及感染指标的诊断价值

The Characteristics of Drug Resistance of Pathogenic Bacteria and the Diagnostic Value of Infection Indicators in Diabetic Ketoacidosis Complicated with Infection

目的探析糖尿病酮症酸中毒伴感染患者病原菌的耐药特点及感染指标诊断预测价值。方法选取2016年5月—2021年6月该院重症医学科收治的48例DKA患者,根据是否感染分为感染组22例与无感染组26例,并收集同期无酮症酸中毒、无感染2型糖尿病患者20例为对照组。分析DKA感染组患者病原菌构成情况及耐药特点,对比3组患者感染相关指标,评价感染指标诊断DKA感染的预测价值。结果DKA感染组22例患者共培养分离出病原菌29株,包括革兰阴性菌19株、革兰阳性菌9株、真菌1株,以大肠埃希菌(44.83%)和表皮葡萄球菌(17.24%)为主;大肠埃希菌主要对氨苄西林、哌拉西林、环丙沙星耐药率较高,金黄色葡萄球菌、表皮葡萄球菌对青霉素和红霉素耐药率较高;感染组与无感染组DKA患者各项感染指标均显著高于对照组,3组比较差异有统计学意义(P<0.001),而感染组患者各项感染指标均高于无感染组,两组比较差异有统计学意义(P<0.001);ROC曲线分析显示,感染相关指标联合检测评估预测DKA感染的诊断价值显著高于单项指标诊断价值,差异有统计学意义(P<0.001)。结论DKA伴感染患者病原菌种类主要以革兰阴性菌多见,且革兰阴性菌对β-内酰胺酶抑制剂较为敏感,进行感染指标联合检测诊断DKA感染的预测价值极高。

Objective To explore the drug resistance characteristics of pathogenic bacteria in patients with diabetic ketoacidosis complicated with infection and the diagnostic and predictive value of infection indicators.Methods 48 DKA patients admitted to the department of critical care medicine in the hospital from May 2016 to June 2021 were selected.According to whether they were infected or not,they were divided into an infection group of 22 cases and a non-infection group of 26 cases.20 patients with type 2 diabetes mellitus without ketoacidosis and infection during the same period were collected as the control group.The composition and drug resistance characteristics of pathogenic bacteria in DKA infection group were analyzed.The infection-related indicators of the three groups of patients were compared,and the predictive value of infection indicators in the diagnosis of DKA infection was evaluated.Results 29 pathogenic bacteria were isolated from 22 patients in the DKA infection group,including 19 gram-negative bacteria,9 gram-positive bacteria,and 1 fungus,escherichia coli(44.83%)and staphylococcus epidermidis(17.24%)as the main.Escherichia coli was mainly resistant to ampicillin,piperacillin and ciprofloxacin,and staphylococcus aureus and staphylococcus epidermidis were resistant to penicillin and erythromycin.The infection indexes of DKA patients in the infected group and non-infected group were significantly higher than those in the control group,and the comparison among the three groups was statistically significant(P<0.001).The infection index in the infection group was higher than that in the non-infection group,and the difference was statistically significant between the two groups(P<0.001).The ROC curve analysis showed that the diagnostic value of the combined detection and evaluation of infection-related indicators in predicting DKA infection was significantly higher than the diagnostic value of a single indicator,the difference was statistically significant(P<0.001).Conclusion Gram-negative bacteria are the most common pathogenic bacteria in patients with DKA infection.And Gram-negative bacteria are more sensitive toβ-lactamase inhibitors,and the combined detection of infection indicators has a very high predictive value in the diagnosis of DKA infection.