继发铜绿假单胞菌感染的糖尿病足溃疡患者病情特点及预后分析  

Clinical characteristics and associated prognoses of secondary pseudomonas aeruginosa infection in patients with diabetic foot ulcer

作　　者：项家丽 张杰[2] 王淑敏[1] 何泱[1] 顾俊义[1] 沈亚萍[1] 顾雪明[1] 汤正义[1] Xiang Jiali;Zhang Jie;Wang Shumin;He Yang;Gu Junyi;Shen Yaping;GuXueming;Tang Zhengyi(Department of Endocrine and Metabolic Disease, Yuanyang Subdivision for Diabetic Foot Disease, Shanghai Institute of Endocrine and Metabolie Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, Chin)

机构地区：[1]上海交通大学医学院附属瑞金医院远洋分院糖尿病足治疗中心、上海交通大学医学院附属瑞金医院内分泌代谢病科、上海市内分泌代谢病研究所,200025 [2]辽宁省丹东市中心医院内分泌科,118001

出　　处：《中华内分泌代谢杂志》2018年第5期371-376,共6页Chinese Journal of Endocrinology and Metabolism

基　　金：上海市科学技术委员会科研计划项目（13441900302）

摘　　要：目的分析糖尿病足溃疡（diabetic foot ulcerS，DFU）继发感染铜绿假单胞菌（pseudomonas aeruginosa，PA）的耐药情况，探究继发PA感染的危险因素及其对预后的影响。方法选取966例糖尿病足感染患者，取其足部分泌物进行常规细菌培养，比较原发感染PA和继发感染PA之间的药物敏感性差异，并观察2年内愈合、复发、截肢、心脑血管事件以及死亡等结局。结果13．0％的DFU培养出PA，其中38．1％为继发感染。继发感染PA对妥布霉素、左氧氟沙星、美罗培南、头孢他啶、头孢吡肟的敏感率与原发感染PA相似。然而和原发感染PA相比，继发感染PA对环丙沙星、哌拉西林、哌拉西林他唑巴坦、亚胺培南、庆大霉素、氨曲南、阿米卡星等抗生素的敏感率下降了12％至22％。与原发感染PA的DFU患者相比，继发感染PA者愈合率明显降低，2年的愈合率分别为44．4％和70．4％（P=0．01）。继发感染PA者溃疡不愈合的风险是原发感染者的3倍。此外，校正年龄、性别、Wagner分级、感染程度、糖尿病足病程后，血浆向蛋白水平（P=0．001）是继发PA感染的独立危险因素。结论继发感染PA对抗生素的敏感性较原发感染PA下降，并且继发PA感染的患者足部溃疡愈合更为困难。血浆白蛋白水平是继发PA感染的危险因素．Objective Secondary infection with pseudomonas aeruginosa（PA） in diabetic foot ulcer（DFU） was analyzed to investigate the related risk factor, antibiotic resistance, and prognoses of the infection. Methods Pathogen cultures were carried out in 966 DFU patients with their clinical data collected. All of the patients were followed-up for two years to observe the outcomes, including ulcer healing, amputation, recurrence of ulcers, non- fatal cardiovascular events, and death. The antibiotic susceptibility, risk factors and associated outcome of secondary PA infection were analyzed. Results Total incidence of PA infection was 13.0% in DFU patients, of which 38.1% was secondary. The susceptibility rates of secondary infected PA to tobramycin, meropenem, eftazidime, levofloxacin, cefepime, and cefepime were silnilar to those in primary infected PA. However, the susceptibility rates of secondary infected PA to piperacillin, piperacillin/tazobaetam, ciprofloxacin, imipenen, gentamiein, aztreonam, and amikaein decreased by 12% to 22% as compared with primary infected PA. The healing ,＇ate was much lower in patients with secondary PA infection compared with those with primary PA infection, and the accumulated healing rates at 2 years were 44.44% and 70.4% （ P = 0.01 ） respectively. The risk of ulcer healing failure within two years increased by 3 folds in patients with secondary PA infection. After adjusting for age, sex, Wagner grade, infection grade, and duration of DFU, plasma albumin level was an independent risk factor for secondary PA infection in patients with DFU （ P = 0. 001 ）. Conclusions The antibiotics susceptibility rates of secondary infected PA were lower than those of primary infected PA. Secondary PA infection in DFU was less likely to be healed. Plasma albumin level was a risk factor for secondary PA infection.

关 键 词：糖尿病足溃疡 感染 铜绿假单胞菌 愈合 

分 类 号：R587.2[医药卫生—内分泌]