糖尿病足患者骨髓炎病原菌分布特点及药敏分析  

Distribution characteristics of pathogen and antibiotic susceptibility in diabetic foot osteomyelitis

作　　者：李萌[1] 张会峰 肖二辉[2] 王山梅[3] 齐亚男 罗晶 Li Meng;Zhang Huifeng;Xiao Erhui;Wang Shanmei;Qi Yanan;Luo Jing(Department of Endocrinology,Henan University People′s Hospital,Zhengzhou 450003,China;Department of Infections,Henan Provincial People′s Hospital,Zhengzhou 450003,China;Department of Inspection,Henan Provincial People′s Hospital,Zhengzhou 450003,China;Department of Endocrinology,Henan Provincial People′s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南大学人民医院内分泌科,郑州450003 [2]河南省人民医院感染科,郑州450003 [3]河南省人民医院检验科,郑州450003 [4]河南省人民医院内分泌科,郑州450003

出　　处：《中华内分泌代谢杂志》2020年第2期120-126,共7页Chinese Journal of Endocrinology and Metabolism

基　　金：河南省科技攻关项目(172102310044)。

摘　　要：目的回顾性分析糖尿病足骨髓炎(DFO)患者病原菌分布特点及抗菌药物敏感性。方法收集河南省人民医院内分泌科可疑DFO患者60例,入院后行骨活检明确病理学诊断,骨培养确定病原菌及药敏情况。此外,取患者创面基底部组织行细菌培养,与骨培养结果做对比。结果60例患者行骨活检后确诊为DFO。在60例患者中,共有45例患者同时行骨培养及基底部组织培养,两者结果一致的共有24例,占53.3%。骨培养阳性率为55.0%,其中,革兰阳性菌16株,革兰阴性菌22株,金黄色葡萄球菌(9株)最多见,其次为大肠埃希氏菌(6株)。骨培养阳性组中糖尿病足病程、白蛋白(ALB)、入院前抗生素使用率低于骨培养阴性组,白细胞计数(WBC)、C-反应蛋白(CRP)均高于骨培养阴性组,差异有统计学意义(P<0.05)。两组患者的性别、年龄、糖尿病病程、HbA1C、肌酐(CREA)差异无统计学意义(P>0.05)。骨培养结果显示,革兰阳性菌以金黄色葡萄球菌为主,对万古霉素、替加环素、利奈唑胺等较敏感;革兰阴性菌以大肠埃希氏菌为主,对替加环素、碳青霉烯类、阿米卡星等较敏感。结论对可疑DFO患者应及时行骨活检及骨培养明确病原菌,尽量在应用抗生素前规范留取骨组织,根据药敏结果选择合适的抗生素。Objective To retrospectively analyze distribution characteristics of pathogenic bacteria and their antimicrobial susceptibility in patients with diabetic foot osteomyelitis(DFO).Methods Sixty cases of suspected DFO were collected from the Endocrinology Department of Henan Provincial People′s Hospital.After admission,bone biopsy was carried out to confirm the pathological diagnosis,and the pathogenic bacteria and drug sensitivity were determined by bone culture.In addition,bacterial culture was carried out in the basal tissue of the wound,and the results of bacterial culture were compared with those of bone culture.Results Sixty patients were diagnosed as DFO after bone biopsy.Among the 60 patients,45 patients underwent bone culture and basal tissue culture.There are 24 patients of whom the results were consistent,accounting for 53.3%.The positive rate of bone culture was 55.0%,there were 16 strains of gram-positive bacteria and 22 strains of gram-negative bacteria.Staphylococcus aureus(9 strains)occurrence was the most,common finding,followed by Escherichia coli(6 strains).The course of diabetic foot,albumin(ALB),and antibiotic usage rate before admission were lower in bone culture positive group than those in bone culture negative group,while white blood cell(WBC)and C-reactive protein(CRP)were higher in bone culture negative group(P<0.05).There was no significant difference in gender,age,course of diabetes,HbA1C,and creatinine(CREA)levels between the two groups(P>0.05).The results of bone culture showed that Staphylococcus aureus was the main Gram-positive bacteria,which was more sensitive to vancomycin,tigecyclin,linezolid,etc.Escherichia coli was the main Gram-negative bacteria,which was more sensitive to tigecyclin,carbapenems,amikacin,etc.Conclusion Bone biopsy and bone culture should be carried out in cases for suspected DFO patients to identify the pathogenic bacteria,and the bone tissue should be preserved and obtained according to the operation specification before the application of antibiotics,and t

关 键 词：糖尿病足骨髓炎 骨活检 骨培养 基底部组织培养 病原菌 抗生素 

分 类 号：R446.5[医药卫生—诊断学] R587.2[医药卫生—临床医学] R681.2