糖尿病足缺血性溃疡的病原菌耐药性分析及控制策略  

The resistance of pathogens in diabetic foot ischemic ulcer patients and control measure

作　　者：杨毅华[1] 黄俊珊[1] 詹巧玲[1] 林超[1] 辜红妮[1] 

机构地区：[1]汕头大学医学院第二附属医院,广东汕头515041

出　　处：《中国热带医学》2006年第5期933-935,共3页China Tropical Medicine

摘　　要：目的探讨糖尿病足缺血性溃疡的病原菌分布,耐药情况及控制策略。方法采用回顾性方法对完整的糖尿病足缺血性溃疡资料72例进行分析。结果72例细菌培养共检出细菌90株,其中革兰阴性杆菌(G-杆菌)57株,占63.3%,革兰阳性球菌(G+球菌)23株,占25.6%,酵母样真菌10株,占11.1%。大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌、金黄色葡萄球菌、表皮葡萄球菌、粪肠球菌是常见致病菌。绝大多数G-杆菌对氨苄西林完全耐药,对哌拉西林/他唑巴坦、第三代头孢含酶抑制剂及碳青霉烯类抗生素耐药性较低,铜绿假单胞菌耐药情况严峻。G+球菌对青霉素、氨苄西林/舒巴坦、苯唑西林、头孢唑林的耐药率均达到100%,对万古霉素的耐药率最低。肠球菌对多数抗生素耐药,已发现1株耐万古霉素的粪肠球菌。结论糖尿病足溃疡以G-杆菌感染居多,耐药情况严峻,强调应重视细菌培养及抗生素敏感试验,合理使用抗生素,降低耐药率。Objective To explore the distribution, drug resistance and controlling strategies of the pathogenic bacterium in the diabetic foot isehemic ulcer. Methods The data concerning 72 cases with diabetic ulcerous feet were retrospectively analyzed. Results 90 bacterial strains were isolated from 72 cases, gram negative, gram positive bacteria and fungi were 57 （63.3 % ）, 23 （25.6%） and 10 （ 11. 1% ）, respectively. Common pathogenic bacteria were Escherichia, Pseudomonas aeruginosa （PA）, Klebsiella, Staphylococcus aureus, Staphylococcus epidermidis and Enterococcus. Most of the gram negative bacteria were completely resistant to ampicilin, while few resistant to piperacillin - tazobaetam, cephalosporins and carbapenems. The drug resistance of PA was seriously. Gram positive bacteria were completely resistant tot penicilin, ampicil - sulbactam, oxacillin, cephazolin, but relative sensitive to vancocin. Enterococcus was resistant to most antibiotics and 1 bacterial isolate was observed to be resistant to vancomycin. Conclusion The predominating pathogens responsible for diabetic foot ischemie ulcer are gram negative bacteria and the status of resistance to antibiotics is serious. Thus attention be paid to culture of bacteria, drug sensitivity test and reasonable use of antibiotics so as to reduce the resistance rate.

关 键 词：糖尿病足 溃疡 细菌 耐药 

分 类 号：R587.1[医药卫生—内分泌]