糖尿病患者四肢感染状况研究及截肢危险因素分析  

Study on limb infection in diabetic patients and risk factor analysis of amputation

作　　者：朱晶晶 李淑敏[1] ZHU Jing-jing;LI Shu-min(Ningbo NO.6 Hospital,Zhejiang 315040,China)

机构地区：[1]宁波市第六医院,浙江315040

出　　处：《中国卫生检验杂志》2023年第15期1892-1896,共5页Chinese Journal of Health Laboratory Technology

基　　金：2020年度宁波市医学科技计划项目(2020Y52)。

摘　　要：目的探讨糖尿病患者四肢感染情况及耐药特征,为其预防和控制感染提供科学依据。方法回顾性分析2013年7月—2022年7月在医院住院治疗的糖尿病四肢感染患者的临床资料,分析其菌群分布及药敏结果,探讨导致糖尿病四肢感染患者发生截肢的相关危险因素。结果398例糖尿病四肢感染患者中有162例是糖尿病手部感染和236例糖尿病足部感染。浅部手感染(SHI)中主要以金黄色葡萄球菌、表皮葡萄球菌多见;深部手感染(DHI)中主要以铜绿假单胞菌、大肠埃希菌多见。糖尿病手部感染者中无截肢患者。236例糖尿病足部感染患者截肢58例,多因素logistic回归分析显示,革兰阴性菌检出、HbA_(1c)>9%、Wagner分级≥4级是糖尿病足感染患者截肢的独立危险因素(P<0.05)。结论糖尿病患者SHI和DHI病原菌种类分布有所不同,对抗菌药物的选用应参考药敏试验结果。糖尿病足感染患者截肢率高,应针对高危因素,加强防控措施以降低其感染率。Objective This paper aims to explore the infection of limbs and drug resistance of diabetic patients,so as to provide scientific basis for the prevention and control of infection.Methods The clinical data of hospitalized diabetic patients with limb infection from July 2013 to July 2022 were retrospectively analyzed,and the distribution of bacterial flora and drug sensitivity results were analyzed to explore the related risk factors leading to amputation of diabetic patients with limb infection.Results Among the 398 cases of diabetic limb infection,162 cases were diabetic hand infection and 236 cases were diabetic foot infection.Among superficial hand infections(SHI),Staphylococcus aureus and Staphylococcus epidermidis were the most common.Among the deep hand infections(DHI),Pseudomonas aeruginosa and Escherichia coli were the most common.There was no amputation in diabetic hand infection.Among 236 patients with diabetic foot infection,58 were amputated.Multivariate logistic regression analysis showed that gram-negative bacteria,HbA_(1c)>9 and Wagner's grade≥4 were independent risk factors for amputation of diabetic foot infection(P<0.05).Conclusion The distribution of pathogenic bacteria in SHI and DHI in diabetic patients is different,so antimicrobial agents should be selected according to the results of drug sensitivity test.The amputation rate in patients with diabetic foot infection is high,so prevention and control measures should be strengthened to reduce the infection rate.

关 键 词：糖尿病 手部感染 足部感染 截肢 危险因素 

分 类 号：R587.2[医药卫生—内分泌]