糖尿病足住院患者病原菌分布特点与不同Wagner分级相关性  

The Distribution Characteristics of Pathogenic Bacteria in Inpatients with Diabetic Foot were Correlated with Different Wagner Grades

作　　者：秦飞雪 何娟坤 刘师 文斌 朱宏 李静[3] 桂莉 曹小艳 QIN Feixue;HE Juankun;LIU Shi;WEN Bin;ZHU Hong;LI Jing;GUI Li;CAO Xiaoyan(School of Clinical Medicine,Dali University,Dali Yunnan 671003;Department of Endocrinology,The Third People's Hospital of Yunnan Province,Kunming Yunnan 650011;CN 53-1221/R 3 Yunnan Provincial Key Laboratory of Public Health and Biosafety and College of Public Health,Kunming Medical University,Kunming Yunnan 650500,China)

机构地区：[1]大理大学临床医学院,云南大理671003 [2]云南省第三人民医院内分泌科,云南昆明650011 [3]昆明医科大学,云南省公共卫生与生物安全重点实验室暨公共卫生学院,云南昆明650500

出　　处：《昆明医科大学学报》2025年第2期67-73,共7页Journal of Kunming Medical University

基　　金：国家自然科学基金(82160175);云南省“高层次人才培养支持计划”名医专项计划(YNWRMY2020010)。

摘　　要：目的研究云南省第三人民医院住院糖尿病足患者病原菌感染情况及与不同Wagner分级的相关性,了解糖尿病足住院患者感染病原菌特点及相关危险影响因素,进一步为糖尿病足患者抗感染治疗提供理论指导。方法回顾分析云南省第三人民医院2019年1月至2023年1月检测出细菌感染的536例糖尿病足患者的人口数据学资料、足溃疡严重程度、相关实验室检查结果。结果共536例糖尿病足患者培养出病原菌,其中感染革兰氏阳性菌268例(50.0%)、感染革兰氏阴性菌214例(39.9%)、感染真菌2例(0.4%)及感染混合细菌52例(9.7%)。感染革兰氏阳性菌中以金黄色葡萄球菌、表皮葡萄球菌、粪肠球菌为主要病原菌;革兰阴性菌以大肠埃希菌、阴沟肠杆菌、肺炎克雷伯杆菌为主。共有31例多重耐药菌,多重耐药率为(5.78%),其中革兰氏阳性菌中多重耐药均为金黄色葡萄球菌,革兰氏阴性菌中多重耐药菌为鲍曼不动杆菌(1例)、肺炎克雷伯杆菌(2例)、普通变形杆菌(2例)、铜绿假单胞菌(5例)、奇异变形菌(1例)、阴沟肠杆菌(1例)。将536例患者分为Wagner1、2级组(78例)、Wagner3级组(274例)和Wagner4、5级组(184例)。Wagner1、2级组感染单一细菌73例,混合细菌5例,其中包括革兰阳性菌51例(65.4%),革兰阴性菌21例(26.9%),真菌1例(1.3%);Wagner3级组感染单一细菌248例,混合细菌26例。其中感染革兰阳性菌144例(52.6%),革兰阴性菌103例(37.6%),真菌1例(0.4%)。Wagner4、5级组感染单一细菌163例,混合细菌21例。其中感染革兰阳性菌73株(39.7%),革兰阴性菌90株(48.9%),真菌0株(0%)。Wagner1、2、3级患者感染病原菌以革兰阳性菌为主,Wagner4、5级感染病原菌以革兰阴性菌为主。不同Wagner分级的糖尿病足患者的白细胞计数、中性粒细胞百分比、细菌分类情况、住院天数、血沉、白蛋白差异具有统计学意义(P<0.01),随着Wagner分级增高,患者白细胞计数Objective To study the pathogenic bacteria infection in hospitalized diabetic foot patients in the Third People's Hospital of Yunnan Province and its correlation with different Wagner grades,to understand the the characteristics of pathogenic bacteria and related risk factors in hospitalized diabetic foot patients in the Third People's Hospital of Yunnan Province,and to further provide theoretical guidance for anti-infection treatment of these patients.Methods A retrospective analysis was conducted on the demographic data,severity of foot ulcers,and related laboratory test results of 536 patients with diabetic foot who were detected to have bacterial infection in the Third People's Hospital of Yunnan Province from January 2019 to January 2023.Results Among the 536 diabetic foot patients,pathogenic bacteria were cultured from 268 cases(50.0%)of Gram-positive bacterial infections,214 cases(39.9%)of gram-negative bacterial infections,2 cases(0.4%)of fungal infections,and 52 cases(9.7%)of mixed bacterial infections.The main pathogens among gram-positive bacteria were Staphylococcus aureus,Staphylococcus epidermidis and Enterococcus faecalis.for Gram-negative bacteria,the main pathogens were Escherichia coli,Enterobacter cloacae and Klebsiella pneumoniae.There were 31 cases of multi-drug resistant bacteria,and the multi-drug resistance rate was(5.78%).Among Gram-positive bacteria,all multidrug-resistant strains were Staphylococcus aureus,while among Gram-negative bacteria,the multi-drug resistant strains included Acinetobacter baumannii(1 case),Klebsiella pneumoniae(2 cases),Proteus common(2 cases),Pseudomonas aeruginosa(5 cases),Proteus mirabilis(1 case)and Enterobacter cloacae(1 case).The 536 patients were divided into Wagner grade 1 and 2 groups(78 cases),Wagner grade 3 group(274 cases),and Wagner grade 4 and 5 groups(184 cases).There were 73 cases of single bacterial infections and 5 cases of mixed bacterial infections in Wagner grade 1 and 2 group,including 51 cases(65.4%)of gram-positive bacteria,21 cases(26.9%)

关 键 词：糖尿病 糖尿病足 病原菌 Wagner分级 

分 类 号：R587.1[医药卫生—内分泌]