抗菌药物对糖尿病足创面感染铜绿假单胞菌毒素基因表达水平的影响  

Effects of antibacterial drugs on expression levels of toxin genes in Pseudomonas aeruginosa causing diabetic foot wound infection

作　　者：王键 黄冬梅 王延璞 刘堂明 曹建华[3] 刘娟[4] WANG Jian;HUANG Dong-mei;WANG Yan-pu;LIU Tang-ming;CAO Jian-hua;LIU Juan(Yinchuan Hospital of TCM,Yinchuan,Ningxia 750001,China;不详)

机构地区：[1]银川市中医医院外科,宁夏银川750001 [2]银川市中医医院护理部,宁夏银川750001 [3]银川市第一人民医院肝胆外科,宁夏银川750001 [4]宁夏医科大学基础学院,宁夏银川750001

出　　处：《中华医院感染学杂志》2021年第14期2090-2094,共5页Chinese Journal of Nosocomiology

基　　金：宁夏自然科学基金资助项目(NZ13230)。

摘　　要：目的研究美罗培南和头孢他啶治疗糖尿病足(DF)创面铜绿假单胞菌(PA)生物膜感染的疗效及其对毒素基因rsmY、rsmZ、exoS和exoT表达水平的影响。方法将2018年1月-2020年6月银川市中医医院120例DF创面感染患者采用随机数字表法分为A组和B组各60例,均给予负压封闭引流技术治疗,同时A组给予美罗培南静脉滴注每次0.5 g,1/8 h,B组给予头孢他啶静脉滴注每次2.0 g,2/d,疗程为14 d,比较两组创面愈合情况、细菌生物膜(BBF)相关指标以及rsmY、rsmZ、exoS和exoT表达水平。结果A组完成随访58例,B组完成随访56例,两组治疗后压疮愈合计分表(PUSH)评分均降低(P<0.05),且A组治疗14 d和30 d时PUSH评分均低于B组,两组治疗30 d时创面愈合率分别为70.69%和51.79%,差异有统计学意义(P<0.05);两组治疗14 d时BBF吸光度、厚度及活菌数量均降低(P<0.05),且A组BBF吸光度、厚度及活菌数量均低于B组,差异有统计学意义(P<0.05);两组治疗14 d时rsmY、rsmZ、exoS和exoT相对表达量均降低(P<0.05),且A组rsmY和rsmZ相对表达量低于B组,差异有统计学意义(P<0.05)。结论美罗培南和头孢他啶治疗DF创面PA生物膜感染均可有效抑制BBF形成并促进创面愈合,且美罗培南具有一定优势,其原因可能与抑制rsmY和rsmZ表达水平有关。OBJECTIVE To explore the effects of meropenem and ceftazidime on treatment of diabetic foot(DF)wound infection with Pseudomonas aeruginosa and observe the impact on expression levels of toxin genes rsmY,rsmZ,exoS and exoT.METHODS A total of 120 patients with DF wound infection who were treated in Yinchuan Hospital of TCM from Jan 2018 to Jun 2020 were enrolled in the study and randomly divided into the group A and the group B,with 60 cases in each group,both groups were treated with vacuum sealing drainage,the group A was given additional intravenous drip of meropenem,0.5 g each time,1/8 h;the group B was given additional intravenous drip of ceftazidime,2.0 g each time,2 per day,14 days a treatment course.The wound healing status,bacterial biofilm(BBF)-related indexes and expression levels of rsmY,rsmZ,exoS and exoT were observed and compared between the two groups.RESULTS A follow-up was completed for 58 patients in the group A,56 patients in the group B.The pressure ulcer scale for healing(PUSH)score of the two groups was significantly reduced after the treatment(P<0.05),the PUSH scores of the group A were significantly lower than those of the group B after the treatment for 14 and 30 days.The wound healing rates of the two groups were respectively 70.69%and 51.79%after the treatment for 30 days,and there was significant difference(P<0.05).The BBF absorbance,thickness and viable bacterial counts of the two groups were significantly reduced after the treatment for 14 days(P<0.05),and the BBF absorbance,thickness and viable bacteria counts of the group A were significantly less than those of the group B(P<0.05).The relative expression levels of rsmY,rsmZ,exoS and exoT of the two groups were significantly reduced after the treatment for 14 days(P<0.05),and the relative expression levels of rsmY and rsmZ of the group A were significantly lower than those of the group B(P<0.05).CONCLUSION Meropenem and ceftazidime can effectively inhibit the formation of BBF and promote the wound healing of the patients with DF woun

关 键 词：糖尿病足 创面感染 铜绿假单胞菌 生物膜 毒素基因 美罗培南 头孢他啶 

分 类 号：R587.2[医药卫生—内分泌]