不同Wagner分级糖尿病足患者创面分离病原菌分布特点

Distribution characteristics of pathogenic bacteria from diabetic foot ulcer of patients with different Wagner grades

摘要:

目的了解不同Wagner分级糖尿病足患者病原菌分布及耐药情况，为临床合理使用抗菌药物提供依据。方法对2014年1月—2016年12月某院内分泌科收治的糖尿病足患者的临床资料、创面分泌物分离病原菌，以及药物敏感试验结果进行回顾性分析，并将患者按照检出细菌种类不同分为革兰阳性（G+）菌感染组、革兰阴性（G-）菌感染组、混合感染组，分析各组患者临床特征与Wanger分级的关系。结果共有糖尿病足患者103例，G+菌感染组患者39例，G-菌感染组50例，混合感染组14例。混和感染组患者年龄、病程高于其余两组（均P＜0.05）；混和感染组患者糖化血红蛋白（HbA1c）、降钙素原低于其余两组（均P＜0.05）；G+菌感染组患者中性粒细胞百分比高于其他两组（P＜0.01）。共送检标本132份，检出菌株103株，阳性率为78.03%，G+菌与G-菌检出率分别为33.33%（44/132）和44.70%（59/132）。G+菌以金黄色葡萄球菌（19株）和表皮葡萄球菌（11株）为主；G-菌以布氏柠檬酸杆菌（12株）、大肠埃希菌（11株）及铜绿假单胞菌（11株）为主。随着Wagner级别增加，以G+菌与G-菌的混合感染比例持续上升。检出的多重耐药菌以耐甲氧西林金黄色葡萄球菌（MRSA）和产超广谱β内酰胺酶（ESBLs） G-菌为主。结论对于糖尿病足患者，特别是Wagner分级较高患者应及时开展溃疡分泌物的病原学检查与药敏试验，为临床合理使用抗菌药物提供依据。

关键词:

糖尿病足; 病原菌; 耐药性; 合理用药

Abstract:

ObjectiveTo understand the distribution and drug resistance  of pathogenic bacteria from diabetic foot patients of different grades of Wagner classification, and provide basis for the rational use of antimicrobial agents in clinical practice. MethodsClinical data, pathogens isolated from wound secretion, and antimicrobial susceptibility testing result of diabetic foot patients who were admitted in the department of endocrinology in a hospital between January 2014 and December 2016 were analyzed retrospectively, patients were divided into grampositive (G+) bacteria infection group, gramnegative (G-) infection group, and mixed infection group according to the isolation of bacterial species, relationship between patients’ clinical characteristics and Wagner grades was analyzed. ResultsThere were 103 patients with diabetic foot, 39 with G+ bacterial infection, 50 with G- bacterial infection, and 14 with mixed infection. The age and disease course of patients with mixed infection was significantly elder and longer than the other two groups of patients(both P<0.05); glycosylated hemoglobin (HbA1c) and procalciton in mixed infection group were both lower than the other two groups(both P<0.05); the percentage of neutrophils in G+ infection group was higher than the other two groups（P＜0.01）. A total of 132 specimens were detected, 103 strains were isolated, the positive rate was 78.03%, isolation rates of G+ and G- bacteria were 33.33% (44/132) and 44.70% (59/132) respectively. The major G+ strains were Staphylococcus aureus(n=19) and Staphylococcus epidermidis(n=11), the major G- bacteria were Citrobacter braakii(n=12), Escherichia coli(n=11), and Pseudomonas aeruginosa(n=11). As the Wagner grade increased, the proportion of mixed infection continued to rise. The main multidrugresistant organisms were methicillinresistant Staphylococcus aureus  and extendedspectrum betalactamaseproducing G- strains. ConclusionFor diabetic foot patients, especially those with higher Wagner grades, etiological examination and antimicrobal susceptibility testing of ulcer secretion should be timely performed, so as to provide reference for rational use of antimicrobial agents in clinic.

Key words:

diabetic foot; pathogenic bacteria; drug resistance; rational drug use