糖尿病足感染的病原菌及耐药性分析  

Distribution and drug resistance of pathogenic bacteria in diabetic foot infection

作　　者：周滇[1] 王雯[2] 虞俊杰[1] 吕国忠[1] 

机构地区：[1]无锡市第三人民医院烧伤整形科,江苏无锡214041 [2]无锡市第二人民医院内分泌科,江苏无锡214041

出　　处：《临床荟萃》2015年第3期304-307,共4页Clinical Focus

摘　　要：目的调查糖尿病足部感染的病原菌分布、耐药性,分析导致糖尿病足发生耐药菌感染的危险因素。方法选择无锡市第三人民医院与无锡市第二人民医院住院的糖尿病足感染患者110例,取患者足部创面分泌物,置于灭菌试管内,样本1小时内送检,对所培养出的病原菌分布情况和耐药性进行分析,分析糖尿病足发生耐药菌感染的危险因素。结果 110例糖尿病足感染分泌物培养阳性71例,阳性率为64.5%,共分离出病原菌72株,革兰阴性菌43株(59.7%),以铜绿假单胞菌、大肠埃希菌较为常见;革兰阳性菌23株(31.9%),以金黄色葡菌菌、粪肠球菌居多;真菌6例(8.3%);其中革兰阳性菌对万古霉素和头孢类药物的耐药率较低,革兰阴性菌对万古霉素和阿米卡星的耐药率较低。经过单因素和多因素分析发现:糖尿病病程>10年(OR=2.115),使用抗菌药物>2次/年(OR=2.342),出现骨髓炎(OR=4.579)是糖尿病足感染发生耐药的相关危险因素。结论糖尿病足感染的病原菌种类繁多,且对抗生素耐药情况较为普遍,糖尿病足发生耐药菌感染与多种因素有密切的关系,临床应根据耐药菌检测结果合理用药,以降低耐药感染的发生。Objective To explore the distribution and drug resistance of disease producing germ in diabetic foot infection and to analyze the risk factors for diabetic foot infected with drug resistance bacteria. Methods A total of 110 patients with diabetic foot infection treated in the Third People＇s Hospital of Wuxi and the Second People s Hospital of Wuxi were enrolled in this study. The secretion at the wound surface was collected and sent for the bacterial culture within 1 hour. The distribution and drug resistance of pathogenic bacteria were analyzed. Then, the patients were divided into drug resistance group and non-drug resistance group. The risk factors for drug-resistant bacteria infection in diabetic foot were analyzed, too. Results Among the samples from 110 patients, the cultured positive rate was 64.5% （71/110）. A total of 72 strains of pathogens were isolated, among which there were 43 strains of gram-negative bacteria （59, 7~, mainly Pseudomonas aeruginosa and Escherichia coli） and 23 strains of gram-positive bacteria （31.9 ~, mainly Staphylococcus aureus and Enterococcus faecalis）. There were also 6 strains of fungus, accounting for 8.3 %. The resistant rate of gram-positive bacteria against vaneomycin and cephalosporins were low, and that of gram- negative bacteria against vancomycin and amikacin were also low. Duration of diabetes more than 10 years（ OR = 2. 115）, the use of antimicrobial agents more than twice per year （ OR =2. 342） and osteomyelitis （ OR =4. 579） were the risk factors associated with the drug-resistant bacteria infection in diabetic foot. Conclusion The species of pathogens causing the diabetic foot infection are varied and most of them have drug resistance against the main antibiotics. Diabetic foot infection with drug-resistant pathogens is closely related to a variety of factors. Thus, rational use of drugs should be considered according to the multidrug resistant pathogen test so as to reduce the incidence of drug-resistant bacteria infection.

关 键 词：糖尿病足 感染 耐药 危险因素 

分 类 号：R587.29[医药卫生—内分泌]