摘要
目的了解糖尿病足合并感染患者病原菌分布及耐药情况,指导临床合理使用抗菌药物。方法回顾性分析267例糖尿病足患者的临床资料,对分离自溃疡分泌物样本的细菌进行病原菌鉴定及耐药性分析。结果 267份样本中有216份分离出病原菌(292株),阳性检出率为80.9%(216/267)。292株细菌中,革兰阴性杆菌160株(54.8%)、革兰阳性球菌128株(43.8%)、真菌4株(1.4%)。有46例(17.2%)患者存在混合感染。革兰阴性杆菌主要是变形杆菌、大肠埃希菌、阴沟肠杆菌和肺炎克雷伯菌;革兰阳性球菌主要是金黄色葡萄球菌、粪肠球菌和表皮葡萄球菌。药物敏感性试验结果显示,革兰阴性杆菌对碳青霉烯类(亚胺培南、美罗培南和厄他培南)、阿米卡星、头孢吡肟及加β-内酰胺酶抑制剂的抗菌药物耐药率较低,对氨苄西林、哌拉西林和氨曲南耐药率较高;革兰阳性球菌对万古霉素、替考拉宁、利奈唑胺、莫西沙星及利福平较为敏感,对青霉素、红霉素、克林霉素和四环素耐药率较高。耐甲氧西林金黄色葡萄球菌占金黄色葡萄球菌的32.7%(17/52),大肠埃希菌和产超广谱β-内酰胺酶肺炎克雷伯菌分别占44.4%(16/36)和43.5%(10/23)。结论糖尿病足感染的病原菌分布广泛,革兰阴性杆菌较革兰阳性球菌常见,存在一定比例的多重耐药菌。应重视对糖尿病足感染者进行病原菌检测及体外药物敏感性试验,早期选择有效的抗菌药物是治疗糖尿病足感染的关键。
Objective To study the distribution and drug resistance of pathogenic bacteria isolated from infectious patients with diabetic foot,and to provide a reference for using antibiotics rationally. Methods A retrospective study was carried out on the pathogenic bacterium identification and drug resistance isolated from the foot ulcers of 267 patients with diabetic foot. Results Among the 267 patients with diabetic foot,292 isolates of pathogenic bacteria were isolated from foot ulcers in 216 patients,and the positive rate was 80.9%(216/267). There were 160(54.8%) isolates of Gram-negative bacilli,128(43.8%) isolates of Gram-positive cocci and 4(1.4%) isolates of fungi. Mixed infection was found in 46(17.2%) patients. Among the 160 isolates of Gram-negative bacilli,Proteus mirabilis,Escherichia coli,Enterobacter cloacae and Klebsiella pneumoniae were prevalent. Among the 128 isolates of Gram-positive cocci,Staphylococcus aureus,Enterococcus faecalis and Staphylococcus epidermidis were prevalent. Drug susceptibility test showed that carbapenems(imipenem,meropenem and ertapenem),amikacin,cefepime and beta lactamase inhibitor were the most effective drugs against Gram-negative bacilli,and the drug resistance rates to ampicillin,piperacillin and aztreonam were high. Gram-positive cocci were sensitive to vancomycin,teicoplanin,linezolid,moxifloxacin and rifampicin,and the drug resistance rates to penicillin,erythromycin,clindamycin and tetracycline were high. Methicillin-resistant Staphylococcus aureus accounted for 32.7%(17/52) of Staphylococcus aureus. Escherichia coli and extended-spectrum beta-lactamases(ESBLs)-producing Klebsiella pneumoniae accounted for 44.4%(16/36) and 43.5%(10/23). Conclusions The distribution of pathogenic bacteria causing diabetic foot infection is widespread. Gram-negative bacilli are the main pathogenic bacteria compared with Gram-positive cocci. A certain proportion of pathogenic bacteria are multi-drug resistant bacteria. Attention should be paid to the pathogenic bacteria and drug susceptibi
作者
刘春林
徐波
陈弟
张莉
王飞英
徐红云
刘畅
吕红玲
LIU Chunlin;XU Bo;CHEN Di;ZHANG Li;WANG Feiying;XU Hongyun;LIU Chang;Lü Hongling(Department of Clinical Laboratory,the Second People's Hospital of Yunnan Province,the First Hospital of Yunnan Province,Kunming 650021,Yunnan,China;Department of Endocrinology,the Second People's Hospital of Yunnan Province,the First Hospital of Yunnan Province,Kunming 650021,Yunnan,China;Department of Oral Surgery,the Second People's Hospital of Yunnan Province,the First Hospital of Yunnan Province,Kunming 650021,Yunnan,China)
出处
《检验医学》
CAS
2019年第6期513-517,共5页
Laboratory Medicine
基金
云南省教育厅科学研究基金项目(2013Y285)
关键词
糖尿病足
感染
病原菌
耐药性
Diabetic foot
Infection
Pathogenic bacterium
Drug resistance
