2型糖尿病患者医院感染病原菌分布及耐药性  

Distribution and drug resistance of pathogens causing nosocomial infections in type 2diabetes patients

作　　者：李超林[1] 赵璐杰[2] 

机构地区：[1]青岛大学医学院附属烟台毓璜顶医院内分泌科,山东烟台264000 [2]青岛大学医学院附属烟台毓璜顶医院血液净化中心,山东烟台264000

出　　处：《中华医院感染学杂志》2013年第23期5848-5850,共3页Chinese Journal of Nosocomiology

基　　金：山东省自然科学青年基金资助项目(ZR2011HQ043)

摘　　要：目的了解2型糖尿病(T2DM)患者医院感染的临床特点、病原菌分布及其对抗菌药物的耐药性。方法对内分泌科2009年1月-2011年12月住院52例T2DM患者医院感染临床资料进行回顾性分析。结果 52例医院感染患者感染部位主要为泌尿系(25例)、呼吸道(18例)、肝脓肿(4例)、皮肤软组织(3例)及未发现明确感染部位(2例);检出病原菌以革兰阴性菌多见,其中大肠埃希菌26株、肺炎克雷伯菌16株、弗氏柠檬酸杆菌1株、葡萄球菌属7株、其他革兰阳性球菌2株;药敏试验中对革兰阴性杆菌敏感性较高的抗菌药物是亚胺培南及美罗培南,敏感率均为100.00%,其次是头孢哌酮/舒巴坦、哌拉西林/他唑巴坦及阿米卡星,敏感率分别为95.8%、90.5%和88.0%,对革兰阳性球菌敏感抗菌药物多为利奈唑胺、万古霉素、呋喃妥因,敏感率分别为100.0%、85.7%和85.7%。结论 T2DM合并败血症病原菌仍以革兰阴性杆菌多见,主要为大肠埃希菌及肺炎克雷伯菌;临床上早期诊断,积极抗感染治疗,同时应用胰岛素控制血糖,利于改善患者预后,临床宜根据药敏结果选择抗菌药物并合理使用,加强病原菌检测及耐药性监测。OBJECTIVE To analyze the clinical characteristics, pathogen distribution and drug resistance to antibiot-ics of nosocomial infection in type 2 diabetes （T2DM） with sepsis. METHODS A retrospective analysis was conducted on the clinical data of nosocomial infection in 52 cases of hospitalized patients with T2DM from Jan. 2009 to Dec. 2011. RESULTS The main infection sites consisted of urinary tract （n=25）, respiratory tract （n=18）, liver abscess （n=4）, skin and soft tissue （n=3） and unknown site of infection （n=2）. Pathogens were majorly gram-negative bacteria, of which 26 isolates were Escherichia coli, 16 isolates were Klebsiella pneumoni- ae, 1 isolate was Fu citrobacter, and 7 isolates were Staphylococcus, 2 strains were other gram-positive cocci. The major sensitive antibiotics to gram-negative bacilli in Susceptibility test were imipenem and meropenem, with the drug susceptibility rate of 100%, followed by cefoperazone-sulbactam, piperacillin-tazobactam, and amikacin, which were 95.8%, 90.5% and 88%, respectively. The major sensitive antibiotics to gram-positive cocci were linezolid, vancomycin, nitrofurantoin, and the drug susceptibility rates were 100%, 85.7%, and 85.7%, respec-tively. CONCLUSION Pathogens in diabetic patients with sepsis are commonly associated with gram-negative bacil-li, of which E. coli and K. pneumoniae are major pathogens. Early diagnosis, sufficient antibiotic treatment, and effective control blood glucose with insulin may improve the prognosis of patients. It is necessary to reasonably use antibiotics in accordance with the drug susceptibility testing and enhance the detection of pathogens and the moni-toring of drug resistance.

关 键 词：2型糖尿病 败血症 病原菌 抗菌药物 

分 类 号：R378[医药卫生—病原生物学]