老年糖尿病足不同细菌感染类型患者病原菌分布特征及临床价值分析

Analysis of pathogenic bacteria distribution and clinical value in elderly diabetic foot patients with different bacterial infection types

目的 探讨老年糖尿病足(DF)不同细菌感染类型患者病原菌分布特征及临床价值。方法 选取2020年1月至2023年12月于本院诊治的142例老年DF患者作为研究对象,根据创面样本病原菌分布将其分为混合感染组(n=59)和非混合感染组(n=83),观察病原菌分布及耐药性情况;对比临床特征;采用Logistic回归分析影响老年DF患者发生混合细菌感染的相关因素。结果 混合感染组创面中检出118株病原菌,革兰阳性菌占40株(33.80%),革兰阴性菌占78株(66.10%);非混合感染组创面中检出83株病原菌,革兰阳性菌占25株(30.12%),革兰阴性菌占56株(67.47%),真菌占比2株。2组创面病原菌分布比较,差异无统计学意义(P>0.05)。药敏结果显示,两组中金黄色葡萄球菌、表皮葡萄球菌对青霉素G耐药性最高,分别为95.65%、100.00%、66.67%、57.14%;其次为红霉素(86.96%、90.00%、53.33%、42.86%)、阿奇霉素(82.61%、80.00%、46.67%、71.43%)。2组中大肠埃希菌对呋喃妥因耐药性最高,分别为89.47%、68.00%;其次为庆大霉素(73.68%、48.00%)、头孢呋辛(65.79%、40.00%)、复方新诺明(55.26%、40.00%);变形杆菌对头孢噻肟耐药性最高,分别为53.85%、80.00%;其次为庆大霉素(46.15%、70.00%)、头孢地嗪(38.46%、70.00%)。混合感染组与非混合感染组在DF病程、Wagner分级、抗菌药物治疗史、CD4^(+)/CD8^(+)比较中,差异有统计学意义(P<0.05)。Logistic回归分析显示,DF病程延长、Wagner分级4~5级、有抗菌药物治疗史及CD4^(+)/CD8^(+)、ABI下降是老年DF患者发生混合细菌感染的独立影响因素(P<0.05)。结论 混合细菌感染病原菌中,以金黄色葡萄球菌+大肠埃希菌占比最高;且DF病程、Wagner分级、抗菌药物治疗史、CD4^(+)/CD8^(+)、ABI会对患者发生混合细菌感染产生影响,临床应提高重视。

Objective To investigate the distribution characteristics and clinical value of pathogenic bacteria in elderly diabetic foot patients with different bacterial infection types.Methods A total of 142 elderly DF patients diagnosed and treated in our hospital from January 2020 to December 2023 were selected as the study objects.According to the distribution of pathogens in wound samples,they were divided into mixed infection group(n=59)and non-mixed infection group(n=83),and the distribution and drug resistance of pathogens were observed.Compare clinical features;Logistic regression was used to analyze the related factors affecting mixed bacterial infection in elderly DF patients.Results In the mixed infection group,118 strains of pathogens were detected,40(33.80%)were gram-positive and 78(66.10%)were gram-negative.In the non-mixed infection group,83 strains of pathogenic bacteria were detected,of which 25 were gram-positive(30.12%),56 were gram-negative(67.47%)and 2 were fungi.There was no significant difference in the distribution of pathogenic bacteria on the wound between the two groups(P>0.05).The results of drug sensitivity showed that Staphylococcus aureus and Staphylococcus epidermidis had the highest resistance to penicillin G,which were 95.65%,100.00%,66.67% and 57.14%,respectively.It was followed by erythromycin(86.96%,90.00%,53.33%,42.86%)and azithromycin(82.61%,80.00%,46.67%,71.43%).The resistance of Escherichia coli to furantoin was the highest in the two groups,89.47%and 68.00%,respectively.It was followed by gentamicin(73.68%,48.00%),cefuroxime(65.79%,40.00%)and cotrimoxazole(55.26,40.00%).The resistance of Proteus to cefotaxime was the highest,53.85%and 80.00%,respectively.It was followed by gentamicin(46.15%,70.00%)and cefodizime(38.46%,70.00%).There were significant differences in DF course,Wagner grade,antibiotic treatment history and CD4^(+)/CD8^(+)between the mixed infection group and the non-mixed infection group(P<0.05).Logistic regression analysis showed that the prolonged course of DF,Wagner grade 4-5,history of antibiotic therapy,CD4^(+)/CD8^(+)and decreased ABI were independent factors for the occurrence of mixed bacterial infection in elderly DF patients(P<0.05).Conclusion Among the pathogens of mixed bacteria infection,S.aureus^(+)E.coli accounted for the highest proportion.In addition,DF course,Wagner grade,antibiotic treatment history,CD4^(+)/CD8^(+),ABI will affect the occurrence of mixed bacterial infection in patients,and clinical attention should be paid to it.