糖尿病足感染患者病原学特点及耐药性分析  

Pathogenic bacteriological characteristics and drug resistance of patients with diabetic foot

作　　者：乐忠宏[1] 汤晓姣[1] 崔婷婷[1] 张洁[1] 王姣[1] 

机构地区：[1]焦作市人民医院内5科,河南焦作454000

出　　处：《中华医院感染学杂志》2017年第3期590-592,601,共4页Chinese Journal of Nosocomiology

基　　金：河南省焦作市科技计划基金资助项目(2014037)

摘　　要：目的探讨糖尿病足老年患者病原学特点并对其进行耐药性分析,对于指导临床用药以及避免耐药菌株的出现提供可靠的理论依据。方法选择医院2011年2月-2013年12月收治的糖尿病足感染患者92例,采集患者足部溃疡分泌物进行细菌分离,对所分离菌株均进行鉴定及药敏分析。结果 92例糖尿病足患者病足分泌物中培养出病原菌90株,其中革兰阳性菌47株占52.2%,革兰阴性菌41株占45.6%,真菌2株占2.2%;47株革兰阳性菌中,≥3种的多药耐药菌16株,占34.0%,其中14株为耐甲氧西林金黄色葡萄球菌(MRSA),葡萄球菌属的药敏性检测过程中未发现耐万古霉素、利奈唑胺菌株,其对青霉素及红霉素的耐药率较高,分别为93.8%及68.8%;41株革兰阴性菌中6株为多药耐药株,占14.6%,其中肠杆菌科4株,铜绿假单胞菌2株,肠杆菌科对氨苄西林及头孢唑林的耐药率最高,均为91.2%。结论对于糖尿病足感染患者的治疗,必须给予相关药敏试验并及时合理的根据药敏试验调整用药,对减少耐药性的发生以及有效的促进患者病足创面的愈合,改善患者预后和生活质量,以降低糖尿病病足的致残率及致死率。OBJECTIVE To investigate the pathogenic bacteriological characteristics of elderly patients with diabetic foot and analyze their drug resistance,so as to provide reliable theoretical basis for guiding the clinical use of drugs and avoiding the appearance of resistant strains.METHODS A total of 92 cases of patients with diabetic foot from Feb.2012 to Dec.2014 in our hospital were selected.Foot ulcer secretions of patients were collected for bacterial isolation,and the isolates were identified and used for drug sensitivity analysis.RESULTS Of the 92 cases of patients with diabetic foot,90 pathogens were cultured and isolated,including 47 strains of gram-positive bacteria,41 strains of gram-negative bacteria,and 2strains of fungi,accounting for 52.2%,45.6%,and 2.2%,respectively.Among 47 strains of gram-positive bacteria,16 strains were multidrug-resistant strains which were resistant to≥3drugs,accounting for 34.0%,in which,14 strains were methicillin-resistant Staphylococcus aureus（MRSA）.Staphylococcus susceptibility testing results showed no vancomycin-resistant and linezolid-resistant strains,and highly resistant to penicillin and erythromycin.41 cases of gram-negative bacteria,the study found A total of 6strains swere multi-drug resistant strains among 41 stains of gram-negative bacteria,accounting for14.6%,including 4strains of Enterobacteriaceae,2stains of Pseudomonas aeruginosa.The resistant rates of Enterobacteriaceae to ampicillin and cefazolin were the highest,which were both 91.2%.CONCLUSIONIn the treatment of patients with diabetic foot infections,it is necessary to give relevant drug susceptibility test and adjust the medication timely and rationally according to the susceptibility test,to reduce the occurrence of drug resistance,promote the healing of patients＇ foot wounds,improve the prognosis and quality of life of patients,and reduce morbidity and mortality of diabetic foot disease.

关 键 词：老年患者 糖尿病足 病原学 耐药性 

分 类 号：R587.2[医药卫生—内分泌]