糖尿病足并发溃疡感染病原菌及其预测模型构建

Pathogens isolated from diabetic foot patients with ulcer infection and establishment of prediction model

目的分析糖尿病足并发溃疡感染病原菌分布特征及其危险因素,并构建预测模型.方法回顾性收集2019年8月-2022年6月新乡市中心医院收治的42例糖尿病足发生溃疡感染患者(感染组)及60例未发生溃疡感染患者(未感染组)临床资料,分析糖尿病足并发溃疡感染病原菌分布,多因素Logistic回归分析糖尿病足并发溃疡感染的危险因素,并构建预测模型,其预测价值采用受试者工作特征(ROC)曲线分析.结果42例糖尿病足并发溃疡感染患者共检出49株病原菌,主要感染病原菌为大肠埃希菌、铜绿假单胞菌、表皮葡萄球菌、金黄色葡萄球菌、白假丝酵母.合并糖尿病大血管病、合并骨髓炎、抗菌药物使用疗程>14 d、抗菌药物联合使用种类≥2种均为糖尿病足并发溃疡感染的危险因素(P<0.05).据此构建的模型预测糖尿病足并发溃疡感染的曲线下面积(AUC)为0.850,敏感度为66.67%,特异度为90.00%.结论糖尿病足患者并发溃疡感染主要感染病原菌种类包括大肠埃希菌、铜绿假单胞菌、表皮葡萄球菌、金黄色葡萄球菌、白假丝酵母,主要危险因素包括合并糖尿病大血管病、合并骨髓炎、抗菌药物使用疗程>14 d、抗菌药物联合使用种类≥2种.

OBJECTIVE To investigate the distribution of pathogens isolated from the diabetic foot patients with ulcer infection,analyze the risk factors and establish the prediction model.METHODS A total of 42 diabetic foot patients who were complicated with ulcer infection and were treated in Xinxiang Central Hospital form Aug 2019 to Jun 2022 were assigned as the infection,and 60 patients who were not complicated with ulcer infection were chosen as the no infection group.The distribution of pathogens isolated form the diabetic foot patients with ulcer infection was observed.Multivariate logistic regression analysis was performed for the risk factors for the ulcer infection,the prediction model was established,and the predictive value of the model was analyzed by means of receiver operating characteristic(ROC)curve.RESULTS Totally 49 strains of pathogens were isolated from 42 diabetic foot patients complicated with ulcer infection.Escherichia coli,Pseudomonas aeruginosa,Staphylococcus epidermidis,Staphylococcus aureus and Candida albus were the predominant species of pathogens.Complication with diabetic large vascular disease,complication with osteomyelitis,antibiotic treatment course more than 14 days and combined use of no less than 2 types of antibiotics were the risk factors for the ulcer infection in the diabetic foot patients(P<0.05).The area under curve(AUC)of the model established based on the risk factors was 0.850 in prediction of the ulcer infection in the diabetic foot patients,with the sensitivity 66.67%,the specificity 90.00%.CONCLUSION The major species of pathogens isolated from the diabetic foot patients with ulcer infec-tion include E.coli,P.aeruginosa,S.epidermidis,S.aureus and C.albus.The major risk factors for the infection include diabetic large vascular disease,complication with osteomyelitis,course of antibiotic treatment more than 14 days and combined use of no less than 2 types of antibiotics.