铜绿假单胞菌感染的糖尿病足患者临床及耐药特点分析  

Clinical features and drug resistance of pseudomonas aeruginosa isolates from patients with diabetic foot infections

作　　者：孙茜[1] 王鹏华[1] 褚月颉[1] 张达[1] 丁群[1] 盂树优[1] 杨蔚[1] 刘倩[1] 李代清[1] 

机构地区：[1]天津医科大学代谢病医院足病科,卫生部激素与发育重点实验室,300070

出　　处：《中华内分泌代谢杂志》2012年第10期817-820,共4页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的分析糖尿病足感染创面分离的铜绿假单胞菌（PA）临床及耐药特点。方法2008年1月至2010年12月从医院428例糖尿病足感染溃疡中分离出85株铜绿假单胞菌，总结患者临床特点，分析耐药菌与溃疡深度、感染严重程度之间的关系；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（1）428例糖尿病足感染患者中革兰氏阳性菌及革兰氏阴性菌检出率分别为50．47％和41．12％：（2）PA占全部检出菌类的19．86％，多药耐药PA为28株，占PA的32．9％；（3）PA感染组溃疡面积大于非PA革兰氏阴性菌感染组及革兰氏阳性感染组（P〈0．05）；（4）与革兰氏阳性菌感染相比，PA感染组患者年龄偏大（P〈0．01）、超敏C反应蛋白水平较高（P〈0．05），血红蛋白水平较低（P〈0．01），缺血性溃疡较多（P〈0．05），骨髓炎发生率较高（P〈0．01）；（5）与革兰氏阳性菌感染组相比，PA更多分离自溃疡较深、感染较重的创面（P〈0．01）；（6）PA对第三代头孢菌素、喹诺酮类、氨基糖苷类抗生素均表现出较高的耐药率．分别在32．9％～61．2％、37．6％～42．4％、37．6％～62．4％之间，发现1例对亚胺培南耐药菌株，占1．2％，而对头孢哌酮／舒巴坦敏感率达100％。结论PA多分离于深部溃疡，且PA引起的感染较重，糖尿病足感染中PA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 pseudomonas aeruginosa （PA） strains isolated from patients with diabetic foot infections （DFI） in Tianjin Metabolic Diseases Hospital. Methods Eighty-five PA strains were isolated from 428 patients with diabetic foot in the hospital from Jan 2008 to Dec 2010. The clinical features of patients were summarized. Relationships between the isolates and depth of ulcer or severity of infection were analyzed. The disk-diffusion method was performed to examine antimierobial susceptibility. Results Gram positive （ G＋ ） and Gram negative （ G ） isolates were 50. 47% and 41. 12% , respectively. Muhidrug-resistant PA composed 32.9% of the total PA isolates. The size of ulcers with PA infections was bigger than those with non-PA bacterial infections （ P〈0.05 ）. Compared to G^＋ strains, patients with PA strains were older, had lower hemoglobin, but higher serum sensitive C-reactive protein; and more frequently, they had isehemie ulcer and osteomyelitls. Compared to G^＋ strains, the PA strains were more frequently isolated from deeper ulcers and with more serious infections（ P〈0.05 ）. The resistant rates of PA to cephalosporins, fluoroquinolones, and aminoglycosides were between 32.9% -61.2% , 37.6% -42.4% , and 37.6% -62.4% , respectively. Only one out of 85 PA strains was imipenem-resistant. However, sensitiveness of all PA isolates to cefoperazone and sulbactam reached 100%. Conclusion PA strains are mainly found in patients with deeper ulcers and more serious infections. Muhidrug-resistant PA is common in DFI. It is important to isolate pathogens and determine their antibiotic resistance correctly in diabetic foot patients in order to provide appropriate drug administration and to reduce the production and dissemination of drug resistant strains.

关 键 词：糖尿病足感染 铜绿假单胞菌 耐药 

分 类 号：R446.5[医药卫生—诊断学]