摘要
目的分析糖尿病足感染(DFI)的病原学、耐药性及相关因素,指导临床治疗。方法以2014年1月至2018年12月我院内分泌科住院治疗的574例糖尿病足患者为研究对象,分析其病原菌分布、药敏情况,并根据足部组织培养结果是否阳性分为A组、B组,分析其相关因素。组间计数资料采用χ2检验,计量资料采用t检验,多因素分析采用Logistic回归分析。结果574例患者分离出病原菌698株,前三位为金黄色葡萄球菌166株(23.8%)、大肠埃希菌54株(7.7%)、阴沟肠杆菌50株(7.2%)。Wagner 3~5级DFI以革兰阴性菌为主,分别占总病原菌株数53.3%、54.8%、71.4%;Wagner 1~2级以革兰阳性菌为主,占62.7%、53.8%。革兰阴性菌(除铜绿假单胞菌、鲍曼不动杆菌外)对美罗培南(敏感率≥98%)、亚胺培南(≥92.6%)、哌拉西林他唑巴坦(≥85.3%)敏感性较高;革兰阳性菌对喹诺酮类抗生素敏感性较高,敏感率≥80%;对万古霉素、利奈唑胺、替加环素敏感性最高,敏感率100%。Logistic回归分析显示,糖尿病足病程长(OR=3.40,95%CI:1.87~6.20)、合并周围血管病变(OR=1.42,95%CI:1.17~1.71)、周围神经病变(OR=1.23,95%CI:2.28~19.69)、白细胞高(OR=4.45,95%CI:1.36~13.25)、糖化血红蛋白高(OR=5.810,95%CI:2.93~11.54)、低密度脂蛋白胆固醇高(OR=1.54,95%CI:1.10~2.15)是导致DFI的主要危险因素。结论临床治疗DFI应根据患者临床特征,经验性选择敏感抗生素,再根据药敏结果调整。
Objective To analyze the pathogen,drug resistance and related factors of diabetic foot infection(DFI)in hospitalized patients.Methods A total of 574 patients with diabetic foot(DF)who were hospitalized in the Department of Endocrinology from January 2014 to December 2018 were studied.The distribution of pathogenic bacteria,drug sensitivity and related factors were collected.Patients were divided into group A or group B based on test result of foot tissue culture,and the related factors were analyzed.SPSS 22.0 software was used for statistics analysis.χ2 test was used for categorical data between groups,t test was used for numerical data,and Logistic regression analysis was used for multivariable analysis.Results 698 strains of pathogenic bacteria were isolated from 574 DF patients.The first three were 166 strains of staphylococcus aureus(23.8%),54 strains of escherichia coli(7.7%)and 50 strains of enterobacter cloacae(7.2%).Wagner grade 3-5 DFI was dominated by gram-negative bacteria,which accounted for 53.3%,54.8%and 71.4%of total pathogenic bacteria respectively.Wagner grade 1-2 was dominated by gram-positive bacteria,accounting for 62.7%and 53.8%.Gram negative bacteria(except for Pseudomonas aeruginosa and Acinetobacter baumannii)were more sensitive to meropenem(sensitivity≥98%),imipenem(≥92.6%),piperacillin/tazobactam(≥85.3%);gram positive bacteria were more sensitive to quinolones(sensitivity≥80%);vancomycin,linezolidine and tegacyclinwere the most sensitive,sensitivity 100%.Logistic regression analysis showed that the length of diabetic foot disease(OR=3.40,95%CI:1.87-6.20),combined with peripheral vascular lesions(OR=1.42,95%CI:1.17-1.71),peripheral neuropathy(OR=1.23,95%CI:2.28-19.69),white blood cells high(OR=4.45,95%CI:1.36-13.25),high glycated hemoglobin(OR=5.810,95%CI:2.93-11.54),low density lipoprotein high(OR=1.54,95%CI:1.10-2.15)was a major risk factor for DFI.Conclusion The treatment of DFI should be determined based on clinical characteristics of patients and empirical selection of sensi
作者
毕然然
许玉华
王绵
刘瑞红
陈枫
牟荣菲
杨昭
Bi Ranran;Xu Yuhua;Wang Mian;Liu Ruihong;Chen Feng;Mu Rongfei;Yang Zhao(Department of Endocrinology,The Second Hospital of HeBei Medical University,Shijiazhuang 050000,China)
出处
《中华糖尿病杂志》
CAS
CSCD
北大核心
2019年第12期782-787,共6页
CHINESE JOURNAL OF DIABETES MELLITUS
关键词
糖尿病足感染
病原菌
耐药性
抗菌药物
Diabetic foot infection
Pathogen
Drug resistance
Antibacterial
