住院患者糖尿病足感染病原菌耐药特征的相关性分析  

Correlation Analysis of Drug Resistance Characteristics of Pathogenic Bacteria in Inpatients with Diabetic Foot Infection

作　　者：何娟坤 秦飞雪 文斌 刘师 李静[3] 桂莉 朱宏 HE Juankun;QIN Feixue;WEN Bin;LIU Shi;LI Jing;GUI Li;ZHU Hong(School of Clinical Medicine,Dali University,Dali Yunnan 671003;Department of Endocrinology,The Third People’s Hospital of Yunnan Province,Kunming Yunnan 650011;School of Public Health Yunnan Provincial Key Laboratory of Public Health and Biosafety 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3期44-50,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：目的分析糖尿病足感染(DFI)患者多重耐药菌(MDRO)的细菌分布特点、耐药特点和相关危险因素。方法收集2019年1月至2023年12月云南省第三人民医院内分泌科收治的300例糖尿病足感染患者的临床资料,根据药物敏感试验结果及基本资料匹配,分为MDRO组(n=60)、非MDRO组(n=240),回顾性分析MDRO的病原菌分布、耐药特点及DFI患者发生MDRO感染的相关危险因素。结果60例MDRO感染患者共培养出MDRO 62株,单种MDRO感染58株,混合MDRO感染4株,其中2例患者分别培养出2种MDRO。在这些菌株中,革兰阳性菌有45株,所占比例为72.58%,且均为金黄色葡萄球菌;革兰阴性菌为17株,占比27.42%,主要包括铜绿假单胞菌、阴沟肠杆菌和肺炎克雷伯菌。常见的MDRO中金黄色葡萄球菌对青霉素G、苯唑西林完全耐药(100%),对红霉素、克林霉素耐药性较高(>80%),对替加环素、万古霉素未产生耐药;肺炎克雷伯菌、阴沟肠杆菌对头孢菌素类抗生素耐药明显,对亚胺培南、阿米卡星耐药率低;铜绿假单胞菌对替卡西林/克拉维酸钾、亚胺培南、替加环素、复方新诺明100%耐药,对头孢吡肟、环丙沙星、庆大霉素、阿米卡星未产生耐药。两组患者的地区分布、糖尿病足病程、下肢动脉病变、静脉血浆葡萄糖、糖化血红蛋白比较差异有统计学意义(P<0.05)。二分类Logistic回归分析显示,地区、糖尿病足病程是DFI患者MDRO感染的独立危险因素(P<0.05)。结论云南部分地区DFI患者MDRO分布主要为革兰阳性菌,不同病原菌对抗生素的敏感性不同,多种因素导致DFI患者发生MDRO感染,有助于临床工作者及早识别MDRO感染的DFI高危患者并为临床治疗提供经验性参考依据。Objective To analyze the bacterial distribution characteristics,drug resistance characteristics and related risk factors of multidrug-resistant organisms(MDRO)in patients with diabetic foot infection(DFI)in some areas of Yunnan Province to provide empirical reference for clinical treatment.Methods Clinical data of 300 DFI patients admitted to the Department of Endocrinology of the Third People's Hospital of Yunnan Province from January 2019 to December 2023 were collected.Based on the results of drug sensitivity tests and matching of basic data,patients were divided into the MDRO group(n=60)and the non-MDRO group(n=240).A retrospective analysis was conducted on the distribution of pathogenic bacteria,drug resistance characteristics of MDRO and risk factors for MDRO infection in DFI patients.Results In 60 patients with MDRO infections,62 strains of MDRO were cultured,with 58 strains from single MDRO infections and 4 strains from mixed MDRO infections.Of the 60 patients,2 were cultured for 2 types of MDRO.Among the strains,there were 45 gram-positive bacteria(72.58%)which were all Staphylococcus aureus,17 strains of gram-negative bacteria(27.42%)mainly including Pseudomonas aeruginosa,Enterobacter cloacae and Klebsiella pneumoniae.Among common MDRO,Staphylococcus aureus showed complete resistance to penicillin G and oxacillin(100%),with high resistance to erythromycin and clindamycin(>80%),but no resistance to tigacycline vancomycin was observed.The resistance of Klebsiella pneumoniae and Enterobacter cloacae to cephalosporin antibiotics was obvious,and the resistance rate to imipenem and amikacin was low.Pseudomonas aeruginosa was 100%resistant to ticacillin/clavulanate potassium,imipenem,tigacycline and cotrimoxazole,but showed no resistance to cefepime,ciprofloxacin,gentamicin and amikacin.There were statistically significant differences between the two groups in regional distribution,duration of diabetic foot,lower extremity arterial disease,venous plasma glucose levels and glycosylated hemoglobin(P<0.05).Binar

关 键 词：糖尿病足感染 病原菌耐药 危险因素 管理措施 

分 类 号：R587.2[医药卫生—内分泌]