糖尿病足感染的细菌学特点及下肢动脉病变分析  

Analysis of bacteriological features of diabetic foot infection and lower extremity arterial disease

作　　者：钟子敏 刘飞 吴日强 黄嘉鸿 李天龙 林凤娟 ZHONG Zimin;LIU Fei;WU Riqiang;HUANG Jiahong;LI Tianlong;LIN Fengjuan(Department of Burn Plastic Surgery,Yunfu People's Hospital,Guangdong,Yunfu 527300,China)

机构地区：[1]云浮市人民医院烧伤整形手外科,广东云浮527300

出　　处：《中国医药科学》2021年第10期154-157,共4页China Medicine And Pharmacy

基　　金：广东省云浮市医学科学技术研究立项(2019B024)。

摘　　要：目的探讨糖尿病足感染的细菌学特点及下肢动脉病变情况。方法选择2019年6月1日至2020年8月31日我院收治的60例糖尿病足患者的临床资料进行回顾性分析,统计糖尿病足创面的分布情况,分析不同严重程度的糖尿病足创面分泌物细菌培养及药物敏感试验结果。通过血管彩超或血管CTA(X线计算机断层摄影血管造影术)检查患者下肢动脉闭塞或狭窄的情况。结果糖尿病足创面主要发生在足底及足趾。创面中检出率最高的细菌依次为金黄色葡萄球菌、铜绿假单胞菌、表皮葡萄球菌以及鲍氏不动杆菌。轻度糖尿病足的创面中,革兰阳性菌检出率最高,占比20.00%;中度糖尿病足的创面中,革兰阳性菌、阴性菌检出率差别不大;重度糖尿病足的创面中,革兰阴性菌检出率最高,占比32.50%。细菌培养检出的多重耐药菌株有:金黄色葡萄球菌、铜绿假单胞菌、大肠埃希菌以及表皮葡萄球菌。足背动脉闭塞发生率最高,腓动脉以及腘动脉狭窄率≥50%的发生率相对较低;胫后动脉、胫前动脉、股浅动脉狭窄率≥50%的发生率较高。结论糖尿病足的下肢动脉病变中,足背动脉闭塞发生率最高,胫后动脉、胫前动脉及股浅动脉狭窄率≥50%的发生率较高。对于Wagner分级较高的糖尿病足,细菌培养及药物敏感试验是必要的,能对糖尿病足的抗感染治疗提供可靠依据。Objective To investigate the bacteriological features of diabetic foot infection and lower extremity arterial disease.Methods The clinical data of 60 patients with diabetic foot admitted to our hospital from June 1,2019 to August 31,2020 were analyzed retrospectively.The distribution of diabetic foot wounds was counted,and the results of bacterial culture and drug sensitivity test of secretion of diabetic foot wounds with different severity were analyzed.The occlusion or stenosis of lower extremity artery by vascular color Doppler ultrasonography or vascular CTA(X-ray computed tomography angiography)was investigated.Results The wounds of diabetic foot mainly occurred in the soles of feet and toes.The bacteria with the highest detection rate were Staphylococcus aureus,Pseudomonas aeruginosa,Staphylococcus epidermidis and Acinetobacter baumannii in turn.The detection rate of Gram-positive bacteria was the highest in the wounds of mild diabetic foot,accounting for 20.00%.There was no significant difference between the detection rates of Gram-positive bacteria and Gram-negative bacteria in the wounds of moderate diabetic foot.In the wounds of severe diabetic foot,the detection rate of Gram-negative bacteria was the highest,accounting for 32.50%.The multi-drug resistant strains detected by bacterial culture were Staphylococcus aureus,Pseudomonas aeruginosa,Escherichia coli and Staphylococcus epidermidis.The occlusion incidence of dorsalis pedis artery was the highest,and the stenosis incidence of peroneal artery and popliteal artery≥50%was relatively low.Meanwhile,the stenosis incidence of posterior tibial artery,anterior tibial artery and superficial femoral artery≥50%was relatively high.Conclusion Among the lower extremity arterial diseases of diabetic foot,the occlusion incidence of dorsalis pedis artery is the highest,and the stenosis incidence of posterior tibial artery,anterior tibial artery and superficial femoral artery≥50%is relatively high.Bacterial culture and drug sensitivity test are necessary for d

关 键 词：糖尿病足 感染 细菌 下肢动脉病变 糖尿病足感染 混合感染 细菌学特点 

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