糖尿病足感染患者的病原菌类型与病例特点及预后的相关性

Correlation Between Pathogenic Bacteria Types,Case Characteristics,and Prognosis in Patients with Diabetic Foot Infection

目的分析糖尿病足感染(DFI)不同病原菌类型患者的特点,探讨不同病原菌类型与短期预后的相关性。方法选取2017年1月—2021年6月有病原学结果的住院DFI患者224例,收集患者的一般资料、实验室检查指标、溃疡类型、溃疡严重程度、感染严重程度及预后,根据患者感染的病原菌类型分为革兰阳性(G^(+))菌感染组(n=97)、革兰阴性(G^(-))菌感染组(n=65)以及混合菌感染组(n=62),比较各组患者的病例特点及预后情况。采用多元Logistic回归分析影响预后的危险因素。结果与G^(+)菌感染组比较,G^(-)菌感染的患者年龄显著偏高;G^(-)菌、混合菌感染的患者既往抗菌药物应用比例高,神经型溃疡比例偏低而混合型及缺血型比例显著偏高,Wagner3—5级所占比例大,感染预后偏差,愈合率显著偏低,住院时间显著延长。Logistic回归分析显示,G^(-)菌感染、混合型或缺血型溃疡、糖化血红蛋白(HbA1c)>9%、年龄>65岁是与未愈患者密切相关的危险因素。Wagner3级及以上、G^(-)菌感染、混合型或缺血型溃疡、HbA1c>9%是与截肢患者密切相关的危险因素。结论不同病原菌类型DFI患者的病例特点不同,G^(-)菌感染与混合菌感染的短期预后较差,影响预后的危险因素包含G^(-)菌感染及其病例特点。提示临床可针对患者的病例特点进行综合评估,判断可能病原菌构成,尽早选用合理的抗菌药物进行经验性治疗,以改善预后。

Objective To analyze the case characteristics of different pathogenic bacteria types of diabetic foot infection(DFI)patients,and to explore the correlation between different pathogenic bacteria types and short-term prognosis.Methods A total of 224 hospitalized DFI patients with pathologic results from January 2017 to June 2021 were selected as the study subjects.General data,laboratory test indicators,ulcer type,severity of foot ulcer,severity of foot infection and prognosis of patients were collected.Patients were divided into gram-positive bacteria(G^(+)bacteria)infection group(n=97),gram-negative bacteria(G^(-)bacteria)infection group(n=65)and mixed bacteria infection group(n=62)according to the type of pathogenic bacteria,and the case characteristics and prognosis of each group were compared.Multivariate logistic regression was used to analyze the risk factors affecting prognosis.Results Compared with G^(+)infection group,patients with G^(-)infection had significantly higher age.Patients infected with G^(-)bacteria and mixed bacteria had a high proportion of previous use of antibiotics,the proportion of neurotic ulcers was lower and the proportion of mixed and deficient blood groups was significantly higher and the proportion of Wagner grade 3—5 was large.The infection prognosis was biased,and the healing rate was significantly lower,and the unhealed rate was significantly higher and the time in hospital was longer.Logistic regression analysis showed that G^(-)infection,mixed or ischemic ulcer,HbA1c>9%and age>65 years were the risk factors that were closely related to the uncured patients.Wagner grade 3 and above,G^(-)infection,mixed or ischemic ulcers,and HbA1c>9%were risk factors strongly associated with amputation.Conclusion The case characteristics of DFI patients with different pathogenic bacteria types,and the short-term prognosis of G^(-)bacteria and mixed bacteria was poor,the prognostic risk factors included G^(-)infection and case characteristics.In order to improve the prognosis,a comprehensive evaluation of cases for judgment may be pathogens,choose reasonable antimicrobial agents for empiric treatment as soon as possible.