糖尿病足患者伤口感染的病原菌分布及药敏结果分析  

Distribution and drug susceptibility of pathogens causing wound infections in diabetic foot patients

作　　者：谢光云 吴世木 刘爽[3] 张翠[4] 李升钦 

机构地区：[1]贵州省兴义市人民医院护理部,贵州兴义562411 [2]贵州省兴义市人民医院检验科,贵州兴义562411 [3]贵州省兴义市人民医院内分泌科,贵州兴义562411 [4]贵州省兴义市人民医院手术室,贵州兴义562411 [5]贵州省兴义市人民医院门诊部,贵州兴义562411

出　　处：《中华医院感染学杂志》2017年第17期3897-3900,共4页Chinese Journal of Nosocomiology

基　　金：贵州省科技厅基金资助项目[黔科合SY字(2011)89713]

摘　　要：目的了解糖尿病足患者伤口感染标本的病原菌分布及药敏情况,为临床治疗提供病原学依据。方法选择2015年3月-2016年7月在医院住院治疗的120例糖尿病足伤口感染患者,采集患者伤口深部分泌物送检,对送检标本进行病原菌培养及药敏试验,药敏结果依据美国临床实验室标准化委员会(CLSI)相关标准进行判读。结果 120例糖尿病足伤口感染患者的送检标本中共培养出病原菌118株,其中革兰阳性菌73株占61.9%,以金黄色葡萄球菌和表皮葡萄球菌为主,革兰阴性菌37株占31.3%,以奇异变形菌和肺炎克雷伯菌为主,真菌8株占6.8%;革兰阳性菌对替考拉宁和万古霉素的敏感率为100.0%,其次为米诺环素、呋喃妥因,主要革兰阳性菌对诺氟沙星、苯唑西林、庆大霉素及青霉素的耐药率在27.8%~77.8%;革兰阴性菌对美罗培南、头孢他啶及亚胺培南/西司他丁的敏感率在75.0%~88.9%,而对头孢噻吩、头孢呋辛及替卡西林的耐药率在30.0%以下;真菌中白假丝酵母对氟康唑和伊曲康唑的耐药率在25.0%~50.0%。结论糖尿病足伤口感染患者治疗时,要依据病原菌分布及药敏试验结果合理选择抗菌药物,同时为了避免病原菌种类及其抗菌药物敏感性的变化,在治疗期间要多次对患者病足创面进行病原菌培养和药敏试验,及时、合理的调整用药,以促进患者病足创面的愈合,改善患者预后和生活质量,降低糖尿病足的致残率及致死率。OBJECTIVE To investigate the distribution and drug susceptibility of pathogens isolated from specimens of diabetic foot patients with wound infections so as to provide etiological basis for clinical treatment.METHODS A total of 120 diabetic foot patients with wound infections who were hospitalized from Mar 2015 to Jul 2016 were enrolled in the study,the deep wound secretions were collected and submitted,the submitted specimens were cultured,the drug susceptibility testing was carried out,and the result of the drug susceptibility testing was interpreted on the basis of related standards of National Committee of Clinical Laboratory Standards.RESULTS Totally 118 strains of pathogens were isolated from the submitted specimens of the 120 diabetic foot patients with wound infections,of which 61.9%（73 strains）were gram-positive bacteria,31.3%（37 strains）were gram-negative bacteria,and 6.8%（8 strains）were fungi;Staphylococcus aureus and Staphylococcus epidermidis were the major species of the gram-positive bacteria;Proteus mirabilis and Klebsiella pneumoniae were dominant among the gram-negative bacteria.The drug susceptibility rates of the gram-positive bacteria to teicoplanin and vancomycin were 100.0%,followed by minocycline and nitrofurantoin.The drug resistance rates of the main gram-positive bacteria to norfloxacin,oxacillin,gentamicin and penicillin ranged between 27.8%and 77.8%.The drug susceptibility rates of the gram-negative bacteria to meropenem,ceftazidime and imipenem-cilastatin ranged between 75.0%and 88.9%,however,the drug resistance rates to cefalotin,cefuroxime and ticarcillin were less than 30.0%.Among the fungi,the drug resistance rates of Candida albicans strains to fluconazole and itraconazole ranged between 25.0%and 50.0%.CONCLUSION It is necessary to reasonably use antibiotics for treatment of the diabetic foot patients with wound infection based on the distribution of pathogens and the result of drug susceptibility testing,carry out the bacterial culture of wound secretions and the dr

关 键 词：糖尿病足 脓液 病原学特点 不同敷料 效果分析 

分 类 号：R587.2[医药卫生—内分泌]