糖尿病足感染病原菌分布及临床特征分析

Distribution and clinical characteristics of pathogenic bacteria in diabetes foot infection

目的分析糖尿病感染病原菌分布特征及临床特点。方法回顾性分析2021年1月-2022年4月本院内分泌科住院治疗的95例糖尿病足感染患者资料,采集患者溃疡、坏疽部位底层分泌物进行病原菌培养与分离,并采用全自动微生物鉴定系统进行鉴定。使用SPSS.25对研究对象的病原菌分布结果及糖化血红蛋白(HbA1c)值进行统计分析。结果95例糖尿病足感染患者中,男性66例(69.47%),女性29例(30.53%)。年龄37~82岁,平均年龄(62.46±12.07)岁,糖尿病病程3~39年,平均病程(15.40±9.09)年,糖尿病足病程1~15个月,平均(5.03±3.44)个月。46例(48.42%)患高血脂,49例(51.58%)患高血压,32例(33.68%)患糖尿病肾病。54例(56.84%)合并周围神经病变,59例(62.11%)合并周围血管病变,13例(13.68%)合并下肢动脉病变。Wagner 2级32例(33.68%),Wagner 3级38例(40.00%),Wagner 4级20例(21.05%),Wagner 5级5例(5.27%)。根据Wagner级别将其分为两组,Wagner≤3组共70例(73.68%),Wagner>3组共25例(26.32%)。95例糖尿病足感染患者中74例培养出病原菌,阳性率77.89%。单一感染49例,2种细菌混合感染14例,3种细菌混合感染8例,4种细菌混合感染3例。共分离获得病原菌微生物113株,其中革兰阳性菌65株(57.52%),革兰阴性菌44株(38.94%),真菌4株(3.54%)。以金黄色葡萄球菌、表皮葡萄球菌、粪肠球菌、肺炎克雷伯菌为主要病原菌。Wagner≤3组中49例培养出病原菌,单一感染38例,2种细菌混合感染9例,3种细菌混合感染2例。Wagner>3组中25例培养出病原菌,单一感染11例,2种细菌混合感染5例,3种细菌混合感染6例,4种细菌混合感染3例。Wagner≤3组共培养病原菌62株(54.87%),革兰阳性菌43株(38.05%),革兰阴性菌18株(15.93%),真菌1株(0.88%)。Wagner>3组共培养病原菌51株(45.13%),革兰阳性菌22株(19.47%),革兰阴性菌26株(23.01%),真菌3株(2.65%)。不同分组糖尿病足感染患者的革兰阳性菌和革兰阴性菌分布特征不同,Wagner≤3以革兰阳性菌为主,Wagner>3组以革兰阴性菌为主,差异具有统计学意义(P<0.05)。Wagner≤3组,糖化血红蛋白(HbA1c)平均(9.19±0.78)%,其中29例患者≥9%(41.43%)。Wagner>3组,糖化血红蛋白(HbA1c)平均(10.59±1.86)%,其中16例患者≥9%(64.00%)。两组之间对比HbA1c≥9%占比,Wagner>3组高于Wagner≤3组,差异具有统计学意义(P<0.05)。结论不同Wagner等级的糖尿病足感染病原菌分布不同,Wagner等级越高,越易发生革兰阴性菌感染,临床中应根据不同感染情况正确选择抗菌药物。

Objective To analyze the distribution and clinical characteristics of pathogenic bacteria of diabetes infection.Methods The data of 95 patients with diabetes foot infection hospitalized in the Department of endocrinology of our hospital from January 2021 to April 2022 were retrospectively analyzed.The underlying secretions of ulcer and gangrene were collected for pathogen culture and isolation,and were identificated by the full-automatic microbial identification system.The distribution results of pathogenic bacteria and HbA1 c values of the subjects were statistically analyzed by SPSS.25.Results Among 95 patients with diabetes foot infection,66 were male(69.47%)and 29 were female(30.53%).The age ranged from 37 to 82 years,with an average age of(62.46±12.07)years.The course of diabetes ranged from 3 to 39 years,with an average course of(15.40±9.09)years.The course of diabetes foot ranged from 1 to 15 months,with an average of(5.03±3.44)months.46 cases(48.42%)had hyperlipidemia,49 cases(51.58%)had hypertension,and 32 cases(33.68%)had diabetes nephropathy.54 cases(56.84%)were complicated with peripheral neuropathy,59 cases(62.11%)with peripheral vascular disease,and 13 cases(13.68%)with lower extremity arterial disease.There were 32 cases(33.68%)of Wagner grade 2,38 cases(40.00%)of Wagner grade 3,20 cases(21.05%)of Wagner grade 4,5 cases(5.27%)of Wagner grade 5.They were divided into two groups according to Wagner’s grade.There were 70 cases(73.68%)in Wagner≤3 group and 25 cases(26.32%)in Wagner>3 group.In 95 cases of diabetes foot infection,74 cases of pathogenic bacteria were cultured,and the positive rate was 77.89%.There were 49 cases of single infection,14 cases of mixed infection of two kinds of bacteria,8 cases of mixed infection of three kinds of bacteria and 3 cases of mixed infection of four kinds of bacteria.113 strains of pathogenic microorganisms were isolated,including 65 strains of Gram-positive bacteria(57.52%),44 strains of Gram-negative bacteria(38.94%)and 4 strains of fungi(3.54%).Staphylococcus aureus,Staphylococcus epidermidis,Enterococcus faecalis and Klebsiella pneumoniae were the main pathogens.In Wagner≤3 group,49 cases were cultured with pathogenic bacteria,38 cases were single infection,9 cases were mixed infection with 2 kinds of bacteria,and 2 cases were mixed infection with 3 kinds of bacteria.In Wagner>3 group,25 cases were cultured with pathogenic bacteria,11 cases were single infection,5 cases were mixed infection of 2 kinds of bacteria,6 cases were mixed infection of 3 kinds of bacteria,and 3 cases were mixed infection of 4 kinds of bacteria.In Wagner≤3 group,62 strains of pathogenic bacteria(54.87%),43 strains of Gram-positive bacteria(38.05%),18 strains of Gram-negative bacteria(15.93%),and 1 strain of fungus(0.88%)were cultured.In group Wagner>3,51 pathogenic bacteria(45.13%),22 gram positive bacteria(19.47%),26 gram negative bacteria(23.01%)and 3 fungi(2.65%)were cultured.The distribution characteristics of Gram-positive bacteria and Gram-negative bacteria in patients with diabetes foot infection in different groups were different.Gram-positive bacteria were the main bacteria in Wagner≤3 group,and Gram-negative bacteria were the main bacteria in Wagner>3 group,the difference was statistically significant(P<0.05).In Wagner≤3 group,the mean HbA1 c was(9.19±0.78)%and 29 patients were≥9%(41.43%).In group Wagner>3,the mean HbA1 c was(10.59±1.86)%,of which 16 patients were≥9%(64.00%).The ratio of HbA1 c≥9%between the two groups was significantly higher in Wagner>3 group than Wagner≤3 group(P<0.05).Conclusion The distribution of pathogenic bacteria of diabetes foot infection in different Wagner grades is different.The higher the Wagner grade is,the more likely it is to be infected by gram-negative bacteria.Antibiotics should be correctly selected according to different infection conditions in clinical practice.