糖尿病足溃疡中耐甲氧西林金黄色葡萄球菌感染情况与相应病情和预后  

Clinical characteristics and associated prognosis of methicillin resistant staphylococcus aureus infections in patients with diabetic foot ulcer

作　　者：许蕾[1] 何泱[1] 钱鸿洁[1] 张杉杉[1] 顾雪明[1] 蔡慧丽[1] 顾俊义[1] 施建元[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》2015年第1期28-32,共5页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的 了解糖尿病足感染中金黄色葡萄球菌的培养阳性率及耐药性,分析耐药性的相关危险因素及其对预后的影响.方法 取790例糖尿病足感染患者足部分泌物进行常规细菌培养,分析耐甲氧西林金黄色葡萄球菌（MRSA）感染的药敏情况和患者的临床特点并观察溃疡治愈率、截肢率、死亡率.结果 分泌物培养结果阳性的624例标本中共获得127株金黄色葡萄球菌,MRSA占金黄色葡萄球菌感染的51.2％,在所有足溃疡中检出率为9.1％,其中1例为耐万古霉素的菌株;MRSA主要对万古霉素、利福平、利奈唑胺、替考拉宁等药物敏感性较高.MRSA感染患者的3个月溃疡愈合率为47.7％,截肢率为47.7％,死亡率为9.2％,明显较非MRSA感染患者的预后差（P＜0.05）.抗生素用药史可显著增加MRSA感染几率.结论 久治不愈的糖尿病足感染MRSA培养阳性率较高,MRSA感染提示患者预后较差.Objective To investigate the positive rates of staphylococcus aureus culture and its antibiotic resistance in the patients with diabetic foot infection （DFI）,and to analyse its related risk factors and prognosis.Methods Pretreatment specimens of foot secretion were obtained from 790 patients with DFI and sent for pathogen culture.The antibiotic susceptibility of methicillin resistant staphylococcus aureus （MRSA） infection,clinical characteristics,the healed rates of ulcer,amputation,and mortality were analyzed.Results Among the 624 positive cultures,127 cases turned out to be staphylococcus aureus,of which 51.2% was MRSA.MRSA accouted for 9.1% of all the cultures,and one strain was vancomycin-resistant.MRSA was primarily susceptible to vancomycin,rifampicin,linezolid,teicoplanin and so on.Within three months,47.7% of the patients infected with MRSA were cured,47.7% lost their toes or legs,and 9.2% died,worse prognosis as compared with non-MRSA group （P〈0.05）.History of antibiotic medication suggested higher probability of MRSA infection.Conclusion MRSA infection was mostly detected in refractory diabetic foot infection,and also indicated poor prognosis.

关 键 词：糖尿病足感染 金黄色葡萄球菌 药敏试验 截肢 

分 类 号：R587.2[医药卫生—内分泌]