摘要
目的:分析糖尿病足(DF)细菌感染类型与踝肱指数(ABI)的关系,为临床针对性选择抗菌药物治疗提供参考。方法:收集2018年1月—2019年1月东直门医院周围血管科收治的189例患者,记录踝肱指数(ABI),根据TASC分级分为4组,正常ABI组(0.9<ABI≤1.3),轻度ABI组(0.7<ABI≤0.9),中度ABI组(0.4<ABI≤0.7),重度ABI组(ABI≤0.4),分析四组患者的DF细菌谱特征及对应抗生素敏感程度。结果:189例患者中共培养出212株细菌,有23例混合细菌感染,革兰阴性菌126株(59.43%),革兰阳性菌82株(36.68%)。四组中以革兰阴性菌为主要致病菌。轻度ABI组、中度ABI组中DF细菌感染程度加重(P<0.05)。Spearman相关系数为-0.707,说明DF细菌感染程度与ABI呈负相关(P<0.05)。分析四组革兰阳性菌感染类型,随着ABI指数降低,金色葡萄球菌、粪肠球菌在各组感染比例增多(P<0.05);分析四组革兰阴性菌感染类型,绿脓假单胞菌在感染比例最高(44.0%),其次感染细菌为阴沟肠杆菌(14.29%)。正常ABI组、轻度ABI组、中度ABI组中主要致病菌为表皮葡萄球菌和金色葡萄球菌,敏感抗生素主要为利奈唑胺、万古霉素,重度ABI组主要致病菌为粪肠球菌,敏感抗生素主要为万古霉素、氨苄西林。正常ABI组、轻度ABI组、中度ABI组主要致病菌为绿脓假单胞菌,敏感抗生素主要是阿米卡星、环丙沙星等;重度ABI组主要致病菌为阴沟肠杆菌,敏感抗生素主要为喹诺酮类、头孢四代、碳靑霉烯类等。结论:随着ABI的降低,下肢缺血程度加重,DF感染风险增加,其细菌谱主要特点是革兰阴性菌﹥革兰阳性菌﹥真菌,临床要针对药敏实验结果及时调整抗生素,降低DF感染的概率。
Objective To analyze the correlation between the type of bacterial infection and the sputum index(ABI) in diabetic foot and to provide reference for clinically targeted antibiotic treatment in order to reduce the amputation rate of diabetic foot. Methods A total of 189 patients with vasculature around Dongzhimen Hospital from January 2018 to January 2019 were enrolled. The sputum index(ABI) was recorded and divided into 4 groups according to TASC classification. The normal ABI group(0.9 < ABI ≤ 1.3) was mild. The ABI group(0.7<ABI ≤ 0.9), the moderate ABI group(0.4<ABI ≤ 0.7) and the severe ABI group(ABI ≤ 0.4) analyzed the bacterial characteristics of the four groups and the sensitivity of the corresponding antibiotics. Results A total of 212 strains of bacteria were cultured in 189 patients, including 23 cases of mixed bacterial infection, 126 strains of Gram-negative bacteria(59.43%) and 82 strains of Gram-positive bacteria(36.68%). Gram-negative bacteria were the main pathogens in the four groups. The degree of bacterial infection of diabetic foot was aggravated in mild ABI group and moderate ABI group. With the decrease of ABI index, the infection proportion of Staphylococcus aureus and Enterococcus faecalis in each group increased(P < 0. 05).The correlation coefficient of Spearman was-0.707, and the regression analysis showed that the degree of bacterial infection of diabetic foot was negatively correlated with ABI(P< 0.05).According to the analysis of the infection types of G-bacteria in the four groups, Pseudomonas aeruginosa had the highest infection rate(44.0%,P>0.05), followed by Enterobacter cloacae( 14. 29 %,P < 0. 05). The main pathogens in normal ABI group, mild ABI group and moderate ABI group were Staphylococcus epidermidis and Staphylococcus aureus. The ensitive antibiotics were linezolid and vancomycin.The Enterococcus faecalis were the main pathogens in severe ABI group and the main sensitive antibiotics were vancomycin and ampicillin. The main pathogens in normal ABI group, mild ABI g
作者
杜玉青
李友山
杨博华
杨曦明
吴康
周笑允
陈润铭
安琪
董学宇
段培航
DU Yu-qing;LI Yo-ushan;YANG Bo-hua(Department of Peripheral Vascular,Dongzhimen Hospital of Beijing University of Chinese Medicine,Beijing(100700),China)
出处
《中国中西医结合外科杂志》
CAS
2020年第5期902-909,共8页
Chinese Journal of Surgery of Integrated Traditional and Western Medicine
基金
国家自然科学基金面上项目《基于AGEs-bFGF/PDGF-β通路研究中医外治“溻渍法”促进DF溃疡愈合的分子机制》(81973849-H2709)
北京中医药大学2017“青苗人才”计划(DZMYS-201701)。
关键词
糖尿病足
病原菌
踝肱指数
抗生素
Diabetic foot ulcer
pathogenic bacteria
sputum index
antibiotics
