摘要
目的研究糖尿病足不同溃疡程度的病原菌感染分布及耐药性,为临床用药提供理论依据。方法对医院79例糖尿病足患者的创面分泌物进行病原菌培养和药敏结果分析;采用法国生物梅里埃公司VITEK-2Compact全自动细菌鉴定仪进行细菌鉴定,采用纸片扩散法进行药敏试验,结果判断采用CLSI 2010年标准;采用WHONET5.6软件进行数据分析,组间比较采用χ2检验,各研究变量与糖尿病足溃疡Wagner分级之间的关系采用Spearmen等级相关分析。结果 79例糖尿病足患者中培养阳性65例,阳性率为82.3%,共分离出病原菌101株,其中革兰阳性球菌32株占31.7%,革兰阴性菌66株占65.3%,真菌2株占2.0%,革兰阳性杆菌1株占1.0%;革兰阳性球菌对万古霉素、利奈唑胺均敏感,葡萄球菌属对青霉素均耐药,未发现耐万古霉素金黄色葡萄球菌(VRSA)及耐万古霉素肠球菌(VRE),革兰阴性菌对亚胺培南、美罗培南均敏感;感染患者中单一菌感染29例,感染率36.7%,多重感染36例,感染率45.6%;1级溃疡感染以革兰阳性球菌为主,金黄色葡萄球菌和肠球菌属占75.0%,未发现多药耐药株;2、3级溃疡感染以革兰阴性菌为主;4级均为多重感染。结论糖尿病足溃疡的病原体以革兰阴性菌为主,对亚胺培南、美罗培南均敏感;糖尿病足溃疡程度与病原菌种类无明显相关,而与细菌多药耐药性正相关。
OBJECTIVE To investigate the distribution and drug resistance of pathogens causing difference severities of diabetic foot ulcers so as to provide guidance for clinical use of antibiotics. METHODS The wound secretions obtained from 79 diabetic foot patients were cultured, and the results of drug susceptibility testing were analyzed the bacteria were identified by means of the VITEK-2 Compact automatic bacteria identification system of BioMerieux, France; the drug susceptibility testing was performed with the use of disk diffusion method, and the results were interpreted by referring to criteria of CLSI 2010; the statistical analysis was performed by using WHONET5.6 software, the chi-square test was carried out for comparison between groups, and the correlation between the study variables and the Wagner classification of diabetic foot ulcers was analyzed by means of Spearmen rank correlation analysis. RESULTS Of the 79 patients with diabetic foot, 65 were cuhured positive with the positive rate of 82.3%. A total of 101 strains of pathogens have been isolated, including 32 （31.7%） strains of gram-positive cocci, 66 （65.3%） strains of gram-negative bacteria, and 2 （2.0%） strains of fungi; there was only one （1.0%） strain of gram-negative bacillus. All the gram-positive cocci were susceptible to vancomycin and linezolid; all the Staphylococcus strains were resistant to penicillin; the vancomycin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus have not been detected; all the gram-negative bacteria were susceptible to imipenem and meropenem. Among the 65 patients with infections, 29 cases were with single infection, accounting for 36.7%, and 36 cases were with multiple infections, accounting for 45.6%. The gram-positive cocci were the predominant pathogens causing grade A ulcer, among which the S. aureus and Enterococcus accounted for 75.0 %, the patients with single infection accounted for 66.7%, and the muhidrug-resistant strains have not been detected. The gram-negative bacteria
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2014年第17期4280-4282,共3页
Chinese Journal of Nosocomiology
基金
广东省佛山市卫生局基金资助项目(2012147)
关键词
糖尿病足
溃疡
病原菌
耐药性
Diabetic foot
Ulcer
Pathogen
Drug resistance
