糖尿病足溃疡多重耐药铜绿假单胞菌感染危险因素分析及预后研究  

Risk factor analysis and prognosis study of multi-drug resistant Pseudomonas aeruginosa infection in diabetic foot ulcers

作　　者：牛永菡 杨美荣 张艳 NIU Yong-han;YANG Mei-rong;ZHANG Yan(Department of Endocrinology,Jiaozhou Central Hospital of Qingdao,Qingdao 266300,Shandong,China;Department of Hospital Infection Control,Jiaozhou Central Hospital of Qingdao,Qingdao 266300,Shandong,China)

机构地区：[1]青岛市胶州中心医院内分泌科,山东青岛266300 [2]青岛市胶州中心医院院感科,山东青岛266300

出　　处：《川北医学院学报》2025年第3期393-396,共4页Journal of North Sichuan Medical College

摘　　要：目的:探讨糖尿病足溃疡(DFU)多重耐药铜绿假单胞菌(MDRPA)感染的危险因素,并分析其预后情况。方法:选取296例DFU患者为研究对象,根据细菌培养及药敏试验结果将99例PA感染患者分为MDRPA组(n=54)和非MDRPA组(n=45),其余197例为非PA感染组;采用单因素和Logistic多因素分析糖尿病足溃疡患者MDRPA发生的危险因素,并比较两组患者预后情况。结果:296例患者中,共培养出320株病原菌,以革兰阴性菌163株(50.94%)为主。MDRPA对头孢他啶、头孢吡肟、哌拉西林/他唑巴坦及环丙沙星耐药率均>80%;对左氧氟沙星耐药率<70%。单因素分析显示,MDRPA组患者体质量指数,周围神经病变、周围血管病变、骨髓炎、抗菌药物种类,抗菌药物使用时间等占比高于非MDRPA组(P<0.05);多因素分析显示,骨髓炎、入院前同一溃疡住院史、抗菌药物种类、抗菌药物使用时间及Wagner分级为DFU患者发生MDRPA感染的危险因素(P<0.05)。与非MDRPA组相比,MDRPA组治愈率更低(P<0.05),截肢/趾率更高(P<0.05)。结论:DFU患者MDRPA感染主要致病菌为铜绿假单胞菌,对常见的抗菌药物均有一定的耐药性;DFU患者发生MDRPA感染的危险因素主要有骨髓炎、入院前同一溃疡住院史、抗菌药物种类、抗菌药物使用时间及Wagner分级,且预后较差。Objective:To explore the risk factors of multi-drug resistant Pseudomonas aeruginosa(MDRPA) infection in diabetic foot ulcer(DFU),and to analyze the prognosis status.Methods:296 DFU patients were selected as the study objects,and 99 patients with PA infection(197 patients without PA infection) were divided into MDRPA group(n=54) and non-MDRPA group(n=45) according to the results of bacterial culture and drug susceptibility test.Univariate analysis and Logistic multivariate analysis were performed to analyze the risk factors of MDRPA in patients with DFU,and the prognosis of the two groups was compared.Results:Among 296 patients,320 strains of pathogenic bacteria were cultured,mainly 163 strains of Gram-negative bacteria(50.94%).The drug resistance rates of MDRPA to cephalosporins such as ceftazidime,cefepime,piperacillin/tazobactam and ciprofloxacin were > 80%,and the drug resistance rate to levofloxacin was <70%.The body mass index,proportions of peripheral neuropathy,peripheral vascular disease and osteomyelitis,antibacterial drug type and use time of antibacterial drug in MDRPA group were higher than those in non-MDRPA group(P<0.05).Osteomyelitis,hospitalization history of the same ulcer before admission,antibacterial drug type,use time of antibacterial drug and Wagner grading were risk factors for MDRPA infection in DFU patients(P<0.05).Compared with non-MDRPA group,MDRPA group had lower cure rate(P<0.05) and higher amputation/toe rate(P<0.05).Conclusion:The main pathogenic bacteria of MDRPA infection in DFU patients is Pseudomonas aeruginosa,which has certain resistance to common antibacterial drugs.The main risk factors for MDRPA infection in DFU patients are osteomyelitis,hospitalization history of the same ulcer before admission,type of antibiotics,duration of antibiotic use and Wagner grade.The prognosis of MDRPA patients is poor.

关 键 词：糖尿病足溃疡 多重耐药菌 铜绿假单胞菌 感染 危险因素 药敏 预后 

分 类 号：R378.99[医药卫生—病原生物学]