糖尿病足溃疡伴感染无菌棉拭子擦拭取样及深部组织活检取样细菌培养的一致性研究  

The concordance between culture results from superficial swab and deep tissue biopsy samples in patients with diabetic foot infection

作　　者：邓晓龙[1] 肖立虎 陈大伟[1] 刘关键[2] 孙舒瑶[1] 冉兴无[1] 

机构地区：[1]四川大学华西医院内分泌代谢科糖尿病足诊治中心,成都610041 [2]中国循证医学中心/中国Cochrane中心

出　　处：《中华糖尿病杂志》2014年第7期504-508,共5页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：国家自然科学基金面上项目（81170776）;四川省学术和技术带头人培养基金（JH2014009）;四川省科技支撑计划项目（2011SZ0220）

摘　　要：目的：探讨糖尿病足溃疡伴感染（ DFI）患者溃疡表面无菌棉拭子擦拭取样与深部组织活检取样培养病原菌结果的一致性。方法选取2013年11月至2014年3月四川大学华西医院糖尿病足诊治中心收治的42例DFI患者作为研究对象，同时对溃疡部位进行无菌棉拭子擦拭取样及深部组织活检取样，进行病原菌培养，按诊断性试验统计分析方法分析结果。结果（1）纳入的42例患者中，24例（57.1％）患者足部溃疡处分离出52株病原菌。（2）表浅无菌棉拭子取样培养总的阳性率为65.7％，其中革兰阳性菌（ G＋）占34.8％，革兰阴性菌（ G-）占54.3％；深部组织活检取样总的阳性率为70.0％，其中G＋菌占34.5％，G-菌占53.1％；两种取样方法培养结果比较，差异无统计学意义（χ2＝0.444， P＞0.05）。（3）与深部组织活检取样，表浅无菌棉拭子取样培养对鉴定病原菌的准确度为87.14％，其敏感度和特异度分别为93.48％与75.00％，阳性似然比与阴性似然比分别为3.7391和0.0870，列联系数为0.579，Kappa系数为0.706。结论 DFI患者行表浅无菌棉拭子取样培养与深部组织活检取样的细菌培养结果有较好的一致性，表浅无菌棉拭子取样更简便、易行。Objective To assess the concordance between culture results from wound superficial swab and deep tissue biopsy samples in patients with diabetic foot infection （ DFI ）.Methods Forty-two patients with DFI were enrolled in this study at Diabetic foot care center , Department of Endocrinology and Metabolism of West China Hospital , Sichuan University from November 2013 to March 2014.Superficial swab and deep tissue biopsy specimens were taken from each wound at the end of debridement for culture .Pathogens were isolated and identified at species level by standard methods.The agreement between culture results from wound swabs and tissue samples from the same patient was evaluated by statistical analysis method of diagnostic trial.Results （ 1 ） A total of 70 pairs of samples （ swab and tissue samples ） were available from 42 eligible patients , 52 strains of pathogens were isolated from diabetic foot ulcers in 24/42 （57.1%） patients.（2） The positive ratio of pathogen culture from the superficial swab was similar with deep tissue biopsy specimens （ 65.7% vs 70.0%） , Gram-negative aerobes were most frequently isolated （54.3% vs 53.1%）, followed by gram-positive aerobes （34.8% vs 34.5%）.There are no differences between the methods （χ2 =0.444, P＆gt;0.05）.（3）Overall, 61 （87.14%） of the superficial swab and deep tissue biopsy pairs had identical culture results , but in 18 （29.5%） cases the cultures were sterile; thus,＆amp;nbsp;only 43（82.7%） of the 52 culture-positive pairs had identical results.When compared to deep tissue biopsy specimens culture results , the superficial swab cultures had a overall accuracy of 87.14%.Sensitivity , specificity , positive likelihood ratios （ PLR） , negative likelihood ratios （ NPR） , Contingency Coefficient and Kappa value of swab cultures for the identifying pathogens were 93.48%, 75.00%, 3.739 1, 0.087 0, 0.579 and 0.706, respectively.Conclusion The findings suggest that superficial swab culture are valuable and accurate i

关 键 词：糖尿病足伴感染 细菌培养 病原菌 一致性 

分 类 号：R587.2[医药卫生—内分泌]