重庆地区286例糖尿病足感染患者的病原菌特征、耐药性及代谢因素分析  

Distribution,antibiotic resistance and metabolic factors of pathogenic bacteria in diabetic foot infection:an analysis based on 286 patients in Chongqing

作　　者：杨若梅 周晴 李英莎[1] 何洪波[1] 赵志钢[1] 张和轩[1] 杨莉琴[1] 祝之明[1] 闫振成[1] YANG Ruomei;ZHOU Qing;LI Yingsha;HE Hongbo;ZHAO Zhigang;ZHANG Hexuan;YANG Liqin;ZHU Zhiming;YAN Zhencheng(Department of Hypertension and Endocrinology,Center for Hypertension and Metabolic Diseases,Chongqing Institute of Hypertension,Daping Hospital,Army Medical University(Third Military Medical University),Chongqing,400042,China)

机构地区：[1]陆军军医大学(第三军医大学)大坪医院高血压内分泌科,全军高血压代谢病中心,重庆市高血压研究所,重庆400042

出　　处：《第三军医大学学报》2020年第13期1331-1337,共7页Journal of Third Military Medical University

基　　金：重庆市自然科学基金面上项目(CSTC2019jcyj-msxmX0152)。

摘　　要：目的研究糖尿病足感染(diabetic foot infection, DFI)患者的病原菌特征和药敏试验结果,分析影响足部疾病进展的代谢因素。方法选取从2013年1月至2019年7月在我院高血压内分泌科住院的286例DFI患者为研究对象,无菌采集足部溃疡深部组织进行病原菌培养和鉴定并进行药敏试验,分析DFI患者的病原菌感染类型和药敏试验特征;依据Wagner分级标准,将研究对象分为轻型DFI组和重型DFI组,比较两组之间病原菌特征、耐药性、生化指标情况;采用Spearman相关分析研究影响足部病变的指标;采用二分类Logistic回归评估足部病情加重的危险因素。结果 268例(93.71%)患者共培养出420株病原菌,主要包括金黄色葡萄球菌(21.90%)、铜绿假单胞菌(8.81%)和粪肠球菌(6.67%)等。药敏试验结果表明:14.13%金黄色葡萄球菌为耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus, MRSA);粪肠球菌均为多重耐药(multi-drug resistant, MDR)菌;在肺炎克雷伯菌及大肠埃希菌中,分别有10株(43.48%)和10株(50.00%)为产ESBLs菌株。与轻型DFI患者比较,重型DFI患者由革兰阴性菌混合感染和MDR革兰阴性菌感染的比例升高(P<0.05),且中性粒细胞百分比(neutrophils percentage, NEUT%)、降钙素原(procalcitonin, PCT)和C反应蛋白(C-reactive protein, CRP)水平升高(P<0.05),但体质量指数(body mass index, BMI)、白蛋白(albumin, ALB)、总胆固醇(total cholesterol, TC)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol, HDL-C)、血红蛋白(hemoglobin, Hb)和趾肱指数(toe brachial index, TBI)水平降低(P<0.05)。Spearman相关分析显示:足部病变轻重与PCT、白细胞(white blood cell count, WBC)、NEUT%、CRP和TC呈正相关(P<0.05),与TBI、ALB、Hb、甘油三酯(triglyceride, TG)和HDL-C呈负相关(P<0.05)。Logistic回归分析显示:TC(OR=2.136, 95%CI:1.352~3.372,P=0.001)是糖尿病足部病情加重的危险因素。结论重庆地区重型DFI患Objective To investigate the characteristics and antibiotic resistance of pathogens in patients with diabetic foot infection (DFI) and to analyze the metabolic factors for the progression of foot disease. Methods A total of 286 DFI patients admitted in our department from January, 2013 to July, 2019 were recruited in this study. After tissue specimens were harvested from deep part of infected skin lesions under aseptic condition, the obtained microorganisms were identified and antimicrobial susceptibility tests were carried out. According to Wagner classification standard, the DFI patients were divided into mild and severe DFI groups. Characteristics and drug resistance of pathogenic bacteria and clinical biochemical indexes were analyzed and compared between the 2 groups. Spearman analysis was used to evaluate the correlation between clinical variables and disease progression. Logistic regression analysis was employed to identify the risk factors for exacerbation. Results There were 420 strains of microorganisms isolated from the 268 patients (268/286, 93.71%), including Staphylococcus aureus (21.90%), Pseudomonas aeruginosa (8.81%), and Enterococcus faecalis (6.67%). About 14.13% of Staphylococcus aureus were methicillin-resistant Staphylococcus aureus (MRSA). All the Enterococcus faecalis strains were multidrug resistant (MDR) strains. As for Klebsiella pneumoniae and Escherichia coli, nearly 10 (43.48%) and 10 (50.00%) strains were extended spectrum β-lactamases (ESBLs)-producing bacteria, respectively. The severe DFI group had significantly higher ratios of polymicrobial Gram-negative bacteria and MDR Gram-negative bacteria infections, and increased levels of neutrophils percentage (NEUT%), procalcitonin (PCT), and C-reactive protein (CRP)(all P < 0.05), but had obviously lower body mass index (BMI), decreased albumin (ALB), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and hemoglobin (Hb), and reduced toe brachial index (TBI) (all P < 0.05) when compared with the mild DFI group. Spea

关 键 词：糖尿病足 病原菌 抗生素耐药性 代谢因素 

分 类 号：R195.4[医药卫生—卫生统计学] R372[医药卫生—卫生事业管理]