糖尿病足复发感染病原菌分布及耐药情况分析

Distribution of pathogenic bacteria in recurrent infection of diabetes foot

目的 分析糖尿病足复发感染病原菌分布特点和耐药情况,为糖尿病治疗提供依据。方法 收集2020-2022年本院收治的110例糖尿病足复发感染患者临床资料。采集患者溃疡底部的脓液或分泌物,并培养和送检。药敏试验采用K-B纸片法测定病原菌对临床常用抗生素耐受性。结果 初次感染共计分离出革兰阳性菌49株,革兰阴性菌58株和真菌3株。其中金黄色葡萄球菌(29株)、大肠埃希菌(21株)、铜绿假单胞菌(15株)和表皮葡萄球菌(12株)是主要致病菌。初次感染中革兰阳性菌对青霉素、红霉素、头孢呋辛、头孢曲松、复方新诺明、四环素、左氧氟沙星、利福平、庆大霉素、阿米卡星和万古霉素耐药率分别为:84.31%、80.39%、43.14%、39.22%、27.45%、5.49%、25.49%、5.88%、25.49%、3.92%和0.00%。革兰阴性菌对氨曲南、左旋氧氟沙星、环丙沙星、头孢曲松、头孢他啶、头孢吡肟、哌拉西林、庆大霉素、阿米卡星、美罗培南、亚胺培南和多粘菌素B耐药率依次为:41.38%、53.45%、50.00%、77.59%、32.76%、32.76%、50.00%、43.10%、6.90%、12.07%、12.07%和0.00%。复发感染感染共计分离出革兰阳性菌35株,革兰阴性菌61株和真菌14株。复发感染中革兰阳性菌对青霉素、红霉素、头孢呋辛、头孢曲松、复方新诺明、四环素、左氧氟沙星、利福平、庆大霉素、阿米卡星和万古霉素耐药率分别为:94.29%、91.43%、71.43%、71.43%、48.57%、57.14%、54.29%、22.86%、54.29%、11.43%和0.00%。革兰阴性菌对氨曲南、左旋氧氟沙星、环丙沙星、头孢曲松、头孢他啶、头孢吡肟、哌拉西林、庆大霉素、阿米卡星、美罗培南、亚胺培南和多粘菌素B耐药率依次为:70.49%、62.30%、63.93%、83.61%、52.46%、52.46%、60.66%、55.74%、14.75%、13.11%、13.11%和0.00%。初次感染产ESBLs大肠埃希菌、产ESBLs肺炎克雷伯菌和MRSA检出率分别为:23.81%、33.33%和17.24%,复发感染产ESBLs大肠埃希菌、产ESBLs肺炎克雷伯菌和MRSA检出率分别为:50.00%、50.00%和52.94%。结论 复发感染与初次感染比较:检出革兰阳性菌减少,真菌增加;病原菌耐药性变强。因而,合理使用抗生素减少耐药菌产生,防止患者感染再次发生。

Objective To analyze the distribution characteristics and drug resistance of pathogenic bacteria of recurrent infection of diabetes foot,and provide basis for the treatment of diabetes.Methods The clinical data of 110patients with recurrent infection of diabetes foot admitted to our hospital from 2020to 2022were collected.The pus or secre-tions from the bottom of the patient's ulcer were collected,and then cultured and submitted for examination.The toler-ance of pathogenic bacteria to commonly used antibiotics in clinical practice were determine by the K-B disk method.Results A total of 49strains of Gram positive bacteria,58strains of Gram negative bacteria,and 3strains of fungi were isolated from the initial infection.Among them,Staphylococcus aureus(29strains),E.coli(21strains),Pseudo-monas aeruginosa(15strains),and Staphylococcus epidermidis(12strains)were the main pathogenic bacteria.The re-sistance rates of gram-positive bacteria to penicillin,erythromycin,cefuroxime,ceftriaxone,compound sulfamethoxazole,tetracycline,levofloxacin,rifampicin,gentamicin,amikacin and vancomycin in the initial infection were 84.31%,80.39%,43.14%,39.22%,27.45%,5.49%,25.49%,5.88%,25.49%,3.92%and 0.00%,respectively.The resistance rates of gram-negative bacteria to aztreonam,levofloxacin,ciprofloxacin,ceftriaxone,ceftazidime,cefepime,piperacillin,gentami-cin,amikacin,meropenem,imipenem and polymyxin B were 41.38%,53.45%,50.00%,77.59%,32.76%,32.76%,50.00%,43.10%,6.90%,12.07%,12.07%and 0.00%,respectively.A total of 35strains of Gram positive bacteria,61strains of Gram negative bacteria,and 14strains of fungi were isolated from recurrent infections.The resistance rates of Gram positive bacteria to penicillin,erythromycin,cefuroxime,ceftriaxone,compound sulfamethoxazole,tetracycline,levofloxa-cin,rifampicin,gentamicin,amikacin and vancomycin in recurrent infections were 94.29%,91.43%,71.43%,71.43%,48.57%,57.14%,54.29%,22.86%,54.29%,11.43%and 0.00%,respectively.The resistance rates of gram negative bacteria to aztreonam,levofloxacin,ciprofloxacin,ceftriaxone,ceftazidime,cefepime,piperacillin,gentamicin,amikacin,meropenem,imipenem and polymyxin B were 70.49%,62.30%,63.93%,83.61%,52.46%,52.46%,60.66%,55.74%,14.75%,13.11%,13.11%and 0.00%,respectively.The detection rates of ESBLs producing Escherichia coli,ESBLs producing Klebsiella pneumoniae,and MRSA in initial infections were 23.81%,33.33%,and 17.24%,respectively.The detection rates of ESBLs producing Escherichia coli,ESBLs producing K.pneumoniae,and MRSA in recurrent infections were 50.00%,50.00%,and 52.94%,respectively.Conclusion Comparison between recurrent infection and initial infection:a decrease in Gram positive bacteria and an increase in fungi were detected;The resistance of pathogenic bacteria has become stronger.Reasonably use antibiotics can reduce the production of drug-resistant bacteria and prevent the recurrence of in-fection in patients.