某三甲医院糖尿病足感染的病原学特征及抗感染药物选择评价  

Evaluations of etiological characteristics and anti-infection regimens of diabetic foot infection at a tertiary hospital

作　　者：石金芳[1] 高杰[1] 王未 朱颖 徐杰[2] 姚青青 SHI Jinfang;GAO Jie;WANG Wei;ZHU Ying;XU Jie;YAO Qingqing(Department of Pharmacy,The First Affiliated Hospital of Soochow University,Jiangsu Suzhou 215000,China;Center of Clinical Laboratory,The First Affiliated Hospital of Soochow University,Jiangsu Suzhou 215000,China)

机构地区：[1]苏州大学附属第一医院,药学部,江苏苏州215000 [2]苏州大学附属第一医院,临检中心,江苏苏州215000

出　　处：《中国医院药学杂志》2024年第9期1075-1081,共7页Chinese Journal of Hospital Pharmacy

摘　　要：目的分析某三甲医院糖尿病足感染的病原学特征并评价抗感染药物选择的合理性。方法回顾性分析2017年1月—2023年3月因糖尿病足感染收住苏州大学附属第一医院内分泌科、足部标本微生物培养阳性且有药敏结果的患者临床资料,包括疾病严重程度、感染指标和病原学等资料,根据指南制定糖尿病足感染治疗的抗感染药物选择评价标准,评价经验性和目标抗感染药物品种选择的合理性。结果共纳入98例患者,其中轻度感染30例、中度感染50例和重度感染18例。感染严重程度不同的患者,白细胞计数、中性粒细胞百分比、C-反应蛋白和降钙素原有显著性差异(P<0.05)。共检出病原菌104株,其中需氧革兰阳性球菌85株,需氧革兰阴性肠杆菌13株及需氧非发酵菌6株。经验性和目标抗感染药物品种选择的不合理率分别为64.6%和63.6%,硝基咪唑类联合其他具有抗厌氧菌活性的药物是不合理用药的主要原因,分别为49例(92.5%)和38例(77.6%)。结论该院糖尿病足感染患者抗感染治疗时抗菌药物选择不恰当,应减少不必要的联合用药。OBJECTIVE To evaluate the etiological characteristics and rationality of anti-infection regimens for diabetic foot infection at a tertiary hospital.METHODS From January 2017 to March 2023,the relevant clinical data were retrospectively reviewed for 98 patients hospitalized for diabetic foot infection with a positive culture and a drug sensitivity result.Patient status,laboratory parameters and pathogenetic characteristics were recorded.The rationality of empirical and targeted anti-infection regimens was evaluated by setting evaluation criteria along with patient status and etiologic outcomes.RESULTS Infection was mild(n=30),moderate(n=50)and severe(n=18).And leucocyte count,neutrophil percentage,C-reactive protein and procalcitonin differed greatly among patients with varying severity of infection(P<0.05).Among 104 pathogenic strains,there were aerobic gram-positive cocci(n=85),aerobic Gram-negative enterobacter(n=13)and aerobic non-fermented Gram-negative bacilli(n=6).The rates of irrational anti-infection regimens of empirical and targeted treatment were 64.6%and 63.6%.Nitroimidazoles in combination with other drugs with anti-anaerobic activity was a major reason for irrational use of both empirical and target treatments,accounting for 49 cases(92.5%)and 38 cases(77.6%)respectively.CONCLUSION Selecting antibiotics for diabetic foot infection patients is inappropriate at this hospital.Unnecessary combination of drugs should be minimized.

关 键 词：糖尿病足感染 病原学 抗菌药物 合理用药 

分 类 号：R969.3[医药卫生—药理学]