糖尿病足溃疡患者耐甲氧西林金黄色葡萄球菌感染致骨髓炎临床分析  

Clinical analysis of diabetic foot ulcers patients with osteomyelitis complicated by MRSA

作　　者：吴猛[1] 李建有[1] 朱剑华[1] 周新华[1] 

机构地区：[1]湖州市中心医院骨科,浙江湖州313000

出　　处：《中华医院感染学杂志》2015年第3期650-652,共3页Chinese Journal of Nosocomiology

基　　金：浙江省卫生厅基金资助项目(2012RCB039)

摘　　要：目的总结糖尿病足溃疡患者耐甲氧西林金黄色葡萄球菌(MRSA)感染致骨髓炎临床特征,并与甲氧西林敏感金黄色葡萄球菌(MSSA)感染患者进行对比。方法调查2007年1月-2011年3月187例糖尿病足溃疡金黄色葡萄球菌感染致骨髓炎患者临床资料,所有患者入院后即行手术治疗,根据细菌培养结果将患者分为MRSA感染组84例及MSSA感染组103例,比较两组患者的临床治疗效果及预后。结果入院时MRSA组患者体温、白细胞计数、组织坏死及恶臭发生率较重,分别为(37.8±8.1)℃、(11.9±2.2)×109/L、56.0%、54.8%,MSSA分别为(36.2±7.3)℃、(6.7±1.2)×109/L、20.4%、17.5%,两组比较差异有统计学意义(P<0.05);MRSA组患者接受手术次数为(2.6±0.6)次多于MSSA组患者的(1.2±0.3)次,差异有统计学意义(P<0.05);MRSA和MSSA组患者肢体保留率分别为79.8%和78.6%,差异无统计学意义。结论在给予及时、有效治疗的情况下,糖尿病足感染MRSA致骨髓炎其预后与MSSA感染患者类似。OBJECTIVE To compare the clinical features of diabetic foot ulcers patients with osteomyelitis caused by methicillin-resistant Staphylococcus aureus （MRSA） with cases caused by methicillin-sensitive Staphylococcus au- reus （MSSA）. METHODS The clinical data of 187 cases of diabetic foot ulcers patients with osteomyelitis caused by S. aureus from Jan. 2007 to Mar. 2011 were investigated. All patients were treated with surgery at the time of being hospitalized. The patients were divided into MRSA infection group and MSSA infection group according to the bacteria culture results. The clinical therapeutic effect and prognosis had been compared. RESULTS MRSA infection group was associated with higher body temperature （37. 8±8.1℃ vs. 36.2±7.3℃） and higher white blood cell count （11.9±2.2× 109/L vs. 6.7±1.2× 109/L） than MSSA infection group. Necrosis （56.0% vs. 20.4%） and fetid smell （54.8% vs. 17.5%） were more frequent in MRSA osteomyelitis. The difference was significant（P〈0.05）. Patients with MRSA infections underwent a greater number of surgical procedures （2.6 ± 0.6） than the MSSA group （1.2 ± 0. 3）. The difference was significant（P〈0.05）. There were no significant difference in limb salvage rates between MRSA and MSSA-related osteomyelitis （79. 8% vs. 78. 6%）. CONCLUSION From our experience, where treatment is based on early and aggressive surgical treatment, the prognosis of MRSA bone infections is similar to MSSA bone infections.

关 键 词：糖尿病足溃疡 感染 耐甲氧西林金黄色葡萄球菌 骨髓炎 

分 类 号：R587.1[医药卫生—内分泌]