某中医院糖尿病足部溃疡病原菌分布及耐药性变迁  

Pathogens distribution and changes in antimicrobial resistance of diabetic foot ulcers in a Chinese medicine hospital

作　　者：王芳[1] 张琼芳[1] 张青[1] 李睿[1] 吴波[1] 任然[1] 辛力华[1] WANG Fang, ZHANG Qiong-Fang, ZHANG Qing, et al(Teaching Hospital of Chengdu University of T.C.M, Sichuan Chengdu 61007)

机构地区：[1]成都中医药大学附属医院检验科,四川成都610072

出　　处：《医学检验与临床》2017年第11期20-24,共5页Medical Laboratory Science and Clinics

摘　　要：目的：了解成都中医药大学附属医院糖尿病患者足部溃疡病原菌感染和耐药性变迁情况,为临床合理用药提供参考.方法：用WHONET 5.6软件筛选2013年～2016年间糖尿病人足部溃疡标本病原菌培养阳性患者,回顾性分析其病历资料,比较分析其病原菌分布及耐药性.结果：504例标本检出病原菌279株（55.36％）,其中革兰氏阳性菌122株（43.73％）,革兰氏阴性菌156株（55.91％）,排名前三位的病原菌为金黄色葡萄球菌、 变形杆菌和铜绿假单胞菌.2013～2016年间金黄色葡萄球菌对青霉素G、 红霉素、 克林霉素等药物耐药率较高,暂未发现对利福平、利奈唑胺和万古霉素耐药的金黄色葡萄球菌,耐甲氧西林金黄色葡萄球菌（MRSA）的检出率分别为0.0％、17.65％、47.62％、25％.在这四年间,变形杆菌对氨苄西林和头孢唑啉耐药率最高,分别为63.6％～100％、80.9％～100.0％,对复方新诺明耐药率在60％左右,对氨曲南、 厄他培南、 阿米卡星、 妥布霉素和三、 四代头孢保持着较高的敏感性.铜绿假单胞菌除在2016年对头孢他啶耐药率为41.2％外,对其他常用抗菌药物耐药率皆小于30％.结论：成都中医药大学附属医院糖尿病足部溃疡分泌物送检量逐年上升,主要病原菌尤其是革兰氏阴性杆菌耐药率在2013～2016年有升高趋势,临床治疗要根据细菌培养及药敏结果合理使用抗生素,以达到更好疗效.Objective： The present study aims to investigate the infection and drug resistance of foot ulcers in patients with diabetes mellitus in teaching hospital of Chengdu University of T.C.M, so as to provide reference for rational drug use in clinic. Methods： Clinical data about the distribution of pathogens and drug resistance relating to the diabetic patients from 2013 to 2016 who had positive culture of foot ulcer specimen was analyzed by WHONET 5.6 software retrospectively. Results： 279 pathogenic bacteria （55.36%） were isolated in 504 specimens, of which 122 were gram positive bacteria （43.73%） and 156 were gram negative bacteria （55.91%）. The top three pathogens were Staphylococcus aureus, Proteus and Pseudomonas aeruginosa respectively. The resistance rate of Staphylococcus aureus to Penicillin G, erythromycin and clindamycin was high. However, no Staphylococcus aureus resistant to rifampin, linezolid and vancomycin was found. The yearly detection rates of MethiciUin-resistant Staphylococcus aureus （MRSA）were 0%, 17.65%, 47.62% and 25% respectively. In the past four years, Proteus resistance to ampicillin and cefazolin was the highest, accounting for 63.6% - 100%, 80.9% - 100.3%, the resistance rate to sulfamethoxazole was about 60%. Nevertheless, Proteus maintained a high susceptibility to aztreonam, ertapenem, Amikacin, tobramycin, the third and fourth generation cephalosporins. The resistance rate ofPseudomonas aeruginosa to commonly used antibiotics was less than 30%, except for a high resistance rate of 41.2% to ceftazidime in 2016. Conclusion： The specimen number of diabetic foot ulcer secretions increased year by year in teaching hospital of Chengdu University of T.C.M. The resistance rate to antimicrobial drugs, increased from 2013 to 2016, especially for Gram-negative bacilli. Antibiotics should be rationally used according to the results of bacterial culture and antimicrobial sensitivity tests for achieving better effects in clinical treatment.

关 键 词：糖尿病足 病原菌 耐药率 

分 类 号：R259.872[医药卫生—中西医结合]