277例糖尿病足感染病原微生物分布及耐药性分析  

Distribution and antimicrobial resistance in 277 cases with diabetic foot infection

作　　者：刘佳为 王渊 徐静 王敏 张春林 童强 LIU Jiawei;WANG Yuan;XU Jing;WANG Min;ZHANG Chunlin;TONG Qiang(Department of Endocrinology,Second Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400037,China)

机构地区：[1]陆军军医大学第二附属医院内分泌科,重庆400037

出　　处：《陆军军医大学学报》2024年第23期2655-2660,共6页Journal of Army Medical University

摘　　要：目的 分析糖尿病足感染病原微生物分布和耐药情况。方法 以横断面调查形式统计2020年1月至2023年1月间我科277例住院糖尿病足患者的病历资料,记录其基本情况、创面特征、病原菌和耐药类型,统计分析病原菌分布、耐药率和多重耐药菌感染的危险因素。结果 在277例患者中共培养出病原微生物228株,包括革兰阳性菌104株,革兰阴性菌115株,真菌7株,放线菌2株。革兰阴性菌在Wagner分级>3级和溃疡病程>30 d的患者中所占比例显著增加。革兰阳性菌对青霉素、红霉素耐药率较高,对万古霉素、利奈唑胺最敏感;革兰阴性菌对三、四代头孢菌素耐药率较低,对碳青霉烯类抗生素最敏感。Wagner分级>3级和溃疡病程>30 d是多重耐药菌感染的独立危险因素。结论 糖尿病足感染病原微生物分布存在异质性,Wagner分级>3级和病程>30 d的病例以革兰阴性菌感染率高,多重耐药菌感染风险高,应及时针对性调整治疗方案。Objective To analyze the distribution and antimicrobial resistance in diabetic foot infection.Methods A cross-section survey was conducted on 277 patients with diabetic foot infection admitted in our hospital between January 2020 and January 2023.Their clinical data were collected,and wound characteristics,pathogenic bacteria and drug resistance were analyzed statistically for the distribution of pathogenic bacteria,drug resistance rate,and risk factors for multidrug-resistant bacterial infections.Results There were 228 strains of pathogenic microorganisms isolated from the 277 patients,including 104 strains of Gram-positive bacteria,115 strains of Gram-negative bacteria,7 strains of fungi,and 2 strains of actinomycetes.The proportion of Gram-negative bacteria was significantly larger in the patients with Wagner grade >3 and course of ulcers >30 d.The isolated Gram-positive bacteria were highly resistant to penicillin and erythromycin,and most of them were sensitive to vancomycin and linezolid.While the Gram-negative ones were highly resistant to the third-and fourth-generation cephalosporins,and most sensitive to carbapenems.Wagner grade >3 and course of ulcers >30 d were independent risk factors for infection of multidrug-resistant organisms.Conclusion There is heterogeneity in the distribution of pathogenic microorganisms in diabetic foot infection.For the patients with Wagner grade >3 and course of ulcers >30 d,they have higher rate of Gram-negative bacterial infection,and are at higher risk of multidrug-resistant bacterial infection,so timely and targeted adjustment should be implemented for their treatment regimens.

关 键 词：糖尿病足 感染 病原菌 耐药 

分 类 号：R372[医药卫生—病原生物学] R587.2[医药卫生—基础医学] R915