糖尿病足感染病原菌分布与病情严重性相关  

Relationship between distribution of pathogenic micro-organism and the severity of diabetic foot ulcer infection

作　　者：张杉杉[1] 顾雪明[1] 刘宏[1] 沈亚萍[1] 方萍[1] 钱泓洁[1] 许蕾[1] 汤正义[1] 宁光[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院内分泌代谢病科,远洋分院内科,上海市内分泌代谢病临床医学中心糖尿病足分中心,上海市内分泌代谢病研究所,200025

出　　处：《中华内分泌代谢杂志》2012年第6期487-491,共5页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的分析糖尿病足感染病原菌分布与足溃疡病情严重性的关系，探讨病原菌分布特点和合理治疗选择。方法90份微生物培养阳性的糖尿病足溃疡感染结果，按照足溃疡病情分Wagner1—5级、感染程度分为轻中重度，统计菌科、菌属、菌种，分析病原菌分布与足溃疡严重性、感染程度等的关系。结果随着糖尿病足溃疡Wagner级别增加、感染程度加重，病原菌谱由以革兰阳性球菌为主（Wagner1级61．1％）转变为以革兰阴性杆菌为主（Wagner5级80．0％），同时混合感染（10．0％～28．6％）、条件致病菌感染增加（83．3％～100％），以革兰阴性杆菌为主的条件致病菌混合感染增加。Wagner分级、感染程度、曾治疗病史及年龄、血糖控制情况、足溃疡病程等共同影响感染类型和病原菌类型（P〈0．05）。结论糖尿病足溃疡病情重、感染重的患者，以革兰阴性杆菌为主的条件致病菌为主的混合感染比例增加，提示临床需针对性应用抗生素。Objective To explore the distribution of pathogenic micro-organisms in the diabetic patients with foot infection, and to investigate the characteristics of the pathogen distribution and its relationship with the severity of diabetic loot ulcer （DFU）. Methods Ninety diabetic foot patients with positive culture of micro-organisms were classified into Wagner 1-5 grades according to the severity of DFU, which was ranked as mild, moderate, and severe infection based on the gradient of infection. The family, genus, and strain of micro-organisms were analyzed, and associated factors were discussed in regard to the kinds and severity of DFU and infection. Results With rising Wagner＇s grades and aggravating infection, the bacterial floras were transformed from gram-positive cocci （61.1% in Wagner 1 ） to gram-negative rods （ 80.0% in Wagner 5 ）, at the same time, composite （ 10.0% to 28.6% ） and opportunist （ 83.3 % to 100% ） infections were increased. Wagner＇s grade, severity of infection, previous treatment, patients＇ age, control of blood glucose, course of DFU, etc, were all related to types of infection and opportunist infection（P〈0. 05 ）. Conclusions Proportion of gram-negative bacilli with opportunist composite infection seems to increase in patients with severe DFU and severe infection requiring appropriate application of antibiotics.

关 键 词：糖尿病足 糖尿病足溃疡 病原菌 条件致病菌 抗生素 

分 类 号：R446.5[医药卫生—诊断学]