糖尿病足下肢血管病变程度对细菌感染病原菌谱及耐药性影响分析

Influence of vascular lesions in lower extremities of diabetic foot patients on spectrum and drug resistance of pathogens causing infection

目的糖尿病足下肢血管病变程度对细菌感染病原菌谱及耐药性的影响。方法纳入2015年1月-2017年3月于新乡医学院第三附属医院862例糖尿病足伴细菌感染患者为研究群体,依据泛大西洋学会联盟(TASC)制定的分级标准,将所选病例分为4组,其中A级组199例;B级229例;C级组248例;D级组186例。采集患者足部溃疡标本进行病原菌培养鉴定及药敏试验,分析感染与下肢血管病变的关系。结果糖尿病足下肢血管病变程度越高,患者深部感染比例越大(P<0.05);862例糖尿病足患者,共检出1 147株病原菌,革兰阳性菌465株占40.54%,革兰阴性菌645株占56.23%,真菌37株占3.23%。C级组和D级组革兰阴性菌所占比例高于A级组和B级组;862例患者中,单一感染患者527例,占比61.14%;混合感染335例,占比38.86%。患者出现混合感染的比例随着下肢血管病变程度的加重而升高,组间比较差异有统计学意义(P<0.05);主要革兰阳性菌表皮葡萄球菌对克林霉素、头孢唑林、氨苄西林、哌拉西林等抗菌药物耐药率较高为100.00%,对利奈唑胺、万古霉素、替考拉宁、利福平等耐药率较低;金黄色葡萄球菌对克林霉素、头孢唑林、氨苄西林、哌拉西林等抗菌药物耐药率较高为100.00%,对替考拉宁、利福平、利奈唑胺、万古霉素等耐药率较低。主要革兰阴性菌铜绿假单胞菌及大肠埃希菌对美罗培南、亚胺培南类抗菌药物耐药率较低。结论随着患者下肢血管病变的加重,多药耐药菌株、混合感染、深部感染的比例升高,临床上对糖尿病患者应该加大对合并下肢血管病变的感染监测,从而降低截肢率。

OBJECTIVE To observe the influence of vascular lesion in lower extremities of the diabetic foot patients on spectrum and drug resistance of pathogens causing infection.METHODS A total of 862 diabetic foot patients complicated with bacterial infection who were treated in third Affiliated Hospital of Xinxiang Medical College form Jan 2015 to Mar 2017 were enrolled in the study and divided into 4 groups according to the grading standards developed by Transatlantic Inter-Society Consensus(TASC):the group A with 199 cases,the group B with 229 cases,the group C with 248 cases,the group D with 186 cases.The foot ulcer specimens were collected,the pathogens were isolated and identified,and the drug susceptibility testing was performed;the correlation between the infection and the vascular lesions of lower extremities was analyzed.RESULTS The higher the degree of vascular lesions of the lower extremities,the greater the proportion of the patients with deep infection((P<0.05).Totally1 147 strains of pathogens were isolated,465(40.54%)of which were gram-positive bacteria,645(56.23%)of which were gram-negative bacteria,and 37(3.23%)were fungi.The proportion of the gram-negative bacteria was higher in the group C and D than in the group A and B.Among the 862 patients,527(61.14%)had single infection,and 335(38.86%)had mixed infection.The proportion of the patients with mixed infection was increased with the aggravation of vascular lesion of the lower extremities,and there was significant difference(P<0.05).Staphylococcus epidermidis was dominant among the gram-positive bacteria,the drug resistance rates of the strains to clindamycin,cefazolin,ampicillin and piperacillin were 100.00%,the drug resistance rates to linezolid,vancomycin,teicoplanin and rifampicin were low;the drug resistance rate of Staphylococcus aureus to clindamycin,cefazolin,ampicillin and piperacillin were 100.00%,and the drug resistance rates to teicoplanin,rifampicin,linezolid and vancomycin were low.Pseudomonas aeruginosa and Escherichia coli were the predominant species of the gram-negative bacteria,and the drug resistance rates of the strains to meropenem and imipenem were low.CONCLUSIONThe proportions of the patients with multidrug-resistant organisms infections,mixed infection and deep infection are increased with the aggravation of vascular lesion of lower extremities.It is necessary for the hospital to strengthen the monitoring of the vascular lesions of lower extremities complicated with infection so as to reduce the amputation rate.