2型糖尿病合并背部脓肿临床特点及菌群分析  

Clinical characteristics and microflora analysis of back abscess in patients with type 2 diabetes mellitus

作　　者：吕丽芳[1] 李萌[1] 赵建军[2] 谢振军[2] 魏君锋[3] 齐亚男 罗晶 张会峰[1] Lyu Lifang;Li Meng;Zhao Jianjun;Xie Zhenjun;Wei Junfeng;Qi Yanan;Luo Jing;Zhang Huifeng(Department of Endocrinology,Henan Provincial People′s Hospital,Zhengzhou 450003,China;Department of Hand and Foot Microsurgery,Henan Provincial People′s Hospital,Zhengzhou 450003,China;Department of Infection,Henan Provincial People′s Hospital,Zhengzhou 450003,China;Department of Endocrinology,Zhengzhou University People′s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院内分泌科,郑州450003 [2]河南省人民医院手足显微外科,郑州450003 [3]河南省人民医院感染科,郑州450003 [4]郑州大学人民医院内分泌科,郑州450003

出　　处：《中华内分泌代谢杂志》2021年第10期919-923,共5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2型糖尿病合并背部脓肿患者的临床特点、菌群分布特点及抗菌药物敏感性。方法收集2017年10月至2020年4月河南省人民医院内分泌科收治的2型糖尿病合并背部脓肿患者的临床资料,分析创面组织或分泌物细菌培养及药敏试验结果,给予抗生素抗感染治疗,根据脓肿情况行脓肿切开清创,必要时给予脓腔置管引流或持续负压吸引治疗,并记录患者临床转归。结果共收集12例2型糖尿病合并背部脓肿患者,脓肿面积平均(150.3±101.2)cm^(2),其中8例(66.7%)面积在100 cm^(2)以上。11例行细菌培养及药敏分析,均显示为金黄色葡萄球菌,培养阳性率为100%,其中甲氧西林敏感的金黄色葡萄球菌(MSSA)菌株10例,耐甲氧西林金黄色葡萄球菌(MRSA)菌株1例。MSSA菌株对苯唑西林、万古霉素、利奈唑胺、左氧氟沙星、莫西沙星、四环素、替加环素、利福平、阿莫西林/克拉维酸、阿米卡星、替考拉宁100%敏感,两类金黄色葡萄球菌菌株共同对万古霉素、利奈唑胺、利福平、阿米卡星和替考拉宁敏感。所有患者创面均愈合,治愈率100%,创面平均愈合时间为(35.8±34.0)d。结论2型糖尿病患者的背部脓肿进展快,脓肿巨大,治疗难度大,应早期及时处理,及时切开引流,其病原菌单一,为金黄色葡萄球菌,有利于经验性选择抗生素。Objective To retrospectively analyze clinical characteristics,flora distribution characteristics,and antimicrobial sensitivity of type 2 diabetic patients with back abscess.Methods The clinical data of patients with type 2 diabetes mellitus and back abscess were collected from Endocrinology Department of Henan Provincial People′s Hospital from October 2017 to April 2020.The results of bacterial culture and drug sensitivity test were analyzed,antibiotics were given to treat infection,incision and debridement of abscess were performed according to the situation of abscess,drainage of abscess cavity or continuous negative pressure suction was given when necessary,and the clinical outcome was recorded.Results A total of 12 type 2 diabetic patients with back abscess were included.The average size of their abscess was(150.3±101.2)cm^(2),with over 100 cm^(2) in 8 cases(66.7%).Among the 12 patients,11 patients underwent bacterial culture and drug sensitivity analysis.The positive rate of culture was 100%,and all of them were Staphylococcus aureus,with 10 cases of methicillin-susceptible Staphylococcus aureus(MSSA)and 1 case of methicillin-resistant Staphylococcus aureus(MRSA).MSSA strains were 100%sensitive to oxacillin,vancomycin,linezolid,levofloxacin,moxifloxacin,tetracycline,tegecycline,rifampicin,amoxicillin/clavulanic acid,amikacin,and teicoplanin.Both MSSA and MRSA strains were sensitive to vancomycin,linezolid,rifampin,amikacin,and teicoplanin.The wound of all patients was healed,with 100%cure rate and(35.8±34.0)days of average healing time.Conclusion The back abscess in type 2 diabetic patients is characteristic of rapid progress,huge abscess,and difficult to treat,which should be treated early,incised and debrided timely.Staphylococcus aureus is its single pathogen and it is helpful to select the antibiotics empirically.

关 键 词：背部脓肿 糖尿病 病原菌 金黄色葡萄球菌 抗生素 

分 类 号：R587.2[医药卫生—内分泌]