糖尿病足感染葡萄球菌属临床及耐药特点分析  

Clinical features and drug resistance of staphylococci causing diabetic foot infections

作　　者：丁群[1] 李代清[1] 冯书红[1] 王鹏华[1] 褚月颉[1] 孟树优[1] 孙茜[1] 

机构地区：[1]天津医科大学代谢病医院卫生部及天津市激素与发育重点实验室,天津300070

出　　处：《中华医院感染学杂志》2011年第3期481-483,共3页Chinese Journal of Nosocomiology

基　　金：天津市自然科学基金资助项目(08JCZDJC25100)

摘　　要：目的分析糖尿病足感染(DFI)创面分离的葡萄球菌属临床及耐药特点。方法 2008年1月-2009年12月从医院277例DFI溃疡中分离出84株金黄色葡萄球菌(SAU)及48株表皮葡萄球菌(SEP),总结132例患者临床特点,分析耐药菌与下肢血液循环及溃疡深度(Wagner分级)间的关系;采用K-B纸片扩散法进行药敏试验,分析细菌耐药特点。结果耐甲氧西林金黄色葡萄球菌(MRSA)及甲氧西林敏感金黄色葡萄球菌(MSSA)、耐甲氧西林表皮葡萄球菌(MRSE)及甲氧西林敏感表皮葡萄球菌(MSSE)中分离自缺血性和Wagner3、4级溃疡的菌株所占比例均高于单纯神经性和Wagner1、2级溃疡;与MSSA相比,MRSA更多分离自Wagner3、4级溃疡,差异有统计学意义(P<0.05);SAU、SEP中多药耐药菌分别占60.7%和72.9%,MRSA、MRSE分别占SAU与SEP的27.4%、33.3%,均为多药耐药菌;MRSA、MRSE对β-内酰胺类、大环内酯类耐药率均>75.0%;MRSE对磺胺甲噁唑/甲氧苄啶耐药率(81.3%)比MRSA(34.8%)高,差异有统计学意义(P<0.01);MSSA、MSSE对青霉素G、大环内酯类耐药率均>60.0%;未发现耐万古霉素菌株。结论耐药葡萄球菌属多见于合并深部溃疡和下肢血运差的患者,DFI中葡萄球菌属多药耐药问题较严重,及时进行正确的细菌培养及药敏检测,可以指导临床合理用药以减少耐药菌的产生及播散。OBJECTIVE To investigate clinical features and antibiotic resistance of Staphylococci isolated from patients with diabetic foot infections（DFI） in Tianjin Metabolic Diseases Hospital.METHODS Totally 84 S.aureus（SAU） and 48 S.epidermidis（SEP） strains were isolated from 277 diabetic foot ulcers in the hospital from Jan 2008 to Dec 2009.The clinical features of 132 patients were summarized.The relationships between the isolates and the ischemic/simple neuropathic ulcers,and the Wagner grades were analyzed.The disk-diffusion method was performed to examine antimicrobial susceptibility.RESULTS Methicillin-resistant/sensititive S.aureus（MRSA/MSSA） and Methicillin-resistant/sensititive S.epidermidis（MRSEP/MSSEP） strains were more frequently isolated from the ischemic ulcers compared to those from the simple neuropathic ones.The isolates from Wagner 3 and 4-grade ulcers possessed higher percentage of drug resistant strains than those from Wagner 1 and 2-grade ulcers.Compared to MSSA,the MRSA strains were more frequently isolated from Wagner 3 and 4-grade ulcers（P0.05）.Multidrug-resistant strains accounted for 60.7% and 72.9% in S.aureus and S.epidermidis isolates,respectively.MRSA（23,to SAU） and MRSEP（16,to SEP） accounted for 27.4% and 33.3%,respectively.All of them were multidrug-resistant strains.The resistant rates of MRSA and MRSEP to β-lactams and macrolides were both over 75.0%,the resistante rate to fluoroquinolones was between 56.3% and 73.9%.MRSEP strains had a significantly higher resistante rate to trimethoprim-sulfamethoxazole than MRSA（81.3% vs 34.8%,P0.01）.MSSA and MSSEP strains were sensitive to almost all the examined antimicrobials except penicillin G and macrolides.All MRSEP strains were sensitive to rifampicin.The resistant rate to rifampicin of MRSEP strains was significantly higher than that of MRSA.None of them were resistant to vancomycin.CONCLUSION Methicillin-resistant Staphylococci are mainly found in patients with deep wounds and poor blood supplication.Mult

关 键 词：糖尿病足感染 耐甲氧西林金黄色葡萄球菌 耐甲氧西林表皮葡萄球菌 

分 类 号：R378.11[医药卫生—病原生物学]