52例糖尿病足患者创面微生物分布及药物敏感分析  

Microbial distribution and drug sensitivity in diabetic foot wounds:Retrospective analysis in 52 cases

作　　者：王帅 吕大伦 李敏 端龙胜 丁伟 王合丽 陈雷 徐姝娟 WANG Shuai;L Dalun;LI Min;DUAN Longsheng;DING Wei;WANG Heli;CHEN Lei;XU Shujuan(Department of Burn&Plastic Surgery,The First Affiliated Hospital of Wannan Medical College,Wuhu 241001,China)

机构地区：[1]皖南医学院第一附属医院弋矶山医院烧伤整形科,安徽芜湖241001 [2]皖南医学院第一附属医院弋矶山医院脊柱外科,安徽芜湖241001

出　　处：《皖南医学院学报》2019年第6期567-571,共5页Journal of Wannan Medical College

基　　金：安徽高校自然科学研究项目(KJ2018A0252)

摘　　要：目的:探讨糖尿病足患者临床资料特点和伤口微生物学与药物敏感特征。方法:选取2016年1月~2018年9月我科收治的52例糖尿病足患者临床资料进行回顾性分析。统计患者糖尿病病程、住院时间与费用、实验室检查指标、伤口分布及创面分泌物微生物培养和药物敏感实验结果。结果:①白细胞升高29例,占55.77%;贫血36例,占69.23%;血小板升高15例,占28.85%;胱抑素C升高23例,占44.23%;糖化血红蛋白升高28例,占53.85%。②糖尿病病程5年及以上发生糖尿病足30例,占57.69%。③糖尿病足创面右足足趾、足底发生率较高。④不同Wagner分级及生化指标患者住院时间、费用比较差异均无统计学意义。⑤创面革兰阳性菌前三位为金黄色葡萄球菌、无乳链球菌及粪肠球菌,革兰阴性菌前三位为大肠埃希菌、奇异变形杆菌及肺炎克雷伯菌肺炎亚种;革兰阳性菌对万古霉素、利奈唑胺及替加环素的灵敏度高,革兰阴性菌对阿米卡星、亚胺培南及厄他培南的灵敏度较高。结论:糖尿病足好发于长期糖尿病患者,相关检查结果与患者病情密切相关,创面常见细菌有金黄色葡萄球菌、无乳链球菌、大肠埃希菌及奇异变形杆菌,随糖尿病足Wagner分级逐渐增高,病原菌由阳性菌向阴性菌转变。Objective:To observe the distribution of microbial strains and drug sensitivity in diabetic foot wounds.Methods:Retrospective analysis was performed in 52 cases of diabetic foot wounds treated in our department between January 2016 and September 2018.The clinical data analyzed in current study included the course of diabetes mellitus,hospital stay and expenses,relevant laboratory test indicators,wound distribution,and findings of microbial culture and drug sensitivity test of the wound secretion.Results:①Increased white blood cells,anemia,and elevated platelet,cystatin-C and glycosylated hemoglobin were seen in 29(55.77%),36(69.23%),15(28.85%),23(44.23%)and 28 cases(53.85%),respectively;②Diabetic foot occurred in 30 patients(57.69%)with disease course of 5 years or over;③Right toe and plantar areas were most involved;④Length of hospital stay and expenses were insignificant in patients with different ulcer extent by Wagner grading system and biochemical indicators;⑤Gram-positive bacteria observed in the wounds consisted of Staphylococcus aureus,Streptococcus agalactiae and Escherichia coli,and Gram-negative bacteria were most composed of Escherichia coli,Bacillus mirabilis and subspecies of Klebsiella pneumonia.Gram-positive bacteria were highly sensitive to vancomycin,linezolamide and tiecocycline,and Gram-negative bacteria to amikacin,imamipenem and etapenam.Conclusion:Diabetic foot easily occurs in patients with long-term diabetes,and relevant test results may closely demonstrate the patient′s condition.Common bacteria in the wounds are involved in Staphylococcus aureus,Streptococcus agalactiae,Escherichia coli and Bacillus mirabilis.The foot ulcer appears aggravated with higher grade by Wagner classification,and gram-positive bacteria tends to shift to negative ones.

关 键 词：糖尿病足 病原菌分布 药物敏感试验 

分 类 号：R587.2[医药卫生—内分泌] R446.5[医药卫生—内科学]