糖尿病足溃疡病原菌分布及多重耐药菌感染的危险因素

Distribution of pathogens and risk factors of multidrugresistant organism infection in patients with diabetic foot ulcer

摘要:

目的了解糖尿病足溃疡患者病原菌分布及多重耐药菌（MDRO）感染相关危险因素，为临床有效防控糖尿病足溃疡MDRO感染提供参考依据。方法选取2011年1月—2016年9月某三甲综合医院内分泌科及骨科收治的糖尿病足溃疡患者。回顾性调查患者的糖尿病足感染情况，对MDRO感染的相关危险因素进行单因素及多因素logistic回归分析。结果共收集糖尿病足溃疡患者135例，检出病原菌122株，其中革兰阴性（G-）菌75株，占61.48%；革兰阳性（G+）菌42株，占34.43%；真菌5株，占4.10%。117株细菌中检出MDRO 76株，MDRO检出率为64.96%，其中大肠埃希菌占22.37%，金黄色葡萄球菌占17.11%，铜绿假单胞菌占15.79%。单因素分析提示，既往使用过抗菌药物、抗菌药物使用疗程＞10 d、抗菌药物联合使用种类＞2种、因相同部位的伤口住院次数＞2次/年、合并骨髓炎、神经缺血性伤口和Wagner 3～5级7个因素为糖尿病足溃疡患者MDRO感染相关危险因素（P＜0.05）。多因素logistic回归分析结果显示，既往使用过抗菌药物、抗菌药物使用疗程＞10 d、因相同部位的伤口住院次数＞2次/年、合并骨髓炎、神经缺血性伤口和Wagner 3～5级是糖尿病足溃疡患者MDRO感染的独立危险因素（P＜0.05）。结论糖尿病足溃疡患者MDRO感染应以预防为主，在临床工作中应注意监测患者局部感染程度及病原菌变化，针对感染病原菌药敏结果合理使用抗菌药物，最大程度减少细菌耐药。

Abstract:

ObjectiveTo understand distribution of pathogens and risk factors of multidrugresistant organism (MDRO) infection in patients with diabetic foot ulcer(DFU), and provide reference for effective clinical prevention and treatment of MDRO infection in patients with DFU. MethodsPatients with DFU and admitted to department of endocrinology and department of orthopedics in a tertiary firstclass general hospital between January 2011 and September 2016 were surveyed. Occurrence of diabetic foot infection was surveyed retrospectively, risk factors for MDRO infection were analyzed by univariate and multivariate logistic regression analysis. ResultsA total of 135 patients with DFU were surveyed, 122 strains of pathogens were isolated, 75 (61.48%) of which were gramnegative bacteria, 42(34.43%) were grampositive bacteria, and 5(4.10%) were fungi. Among 117 isolated strains, 76 were MDRO strains (64.96%), 22.37% of which were Escherichia coli, 17.11% were Staphylococcus aureus, and 15.79% were Pseudomonas aeruginosa. Univariate analysis suggested that 7 risk factors for MDRO infection in patients with DFU were history of antimicrobial use, antimicrobial treatment course＞10 days, combined more than 2 kinds of antimicrobial use, No. of hospitalization＞2 times per year due to wound at the same site, combined with osteomyelitis, neuroischemic wound, and Wagner grade 3-5(P＜0.05）. Multivariate logistic analysis revealed that independent risk factors for MDRO infection in patients with DFU were history of antimicrobial use, antimicrobial treatment course＞10 days, No. of hospitalization＞2 times per year due to wound at the same site, combined with osteomyelitis, neuroischemic wound, and Wagner grade 3-5(P＜0.05）.ConclusionPrevention is the priority of MDRO infection in patients with DFU, monitoring of degree of focal infection and change in pathogens should be paid attention, antimicrobial agents should be used rationally according to susceptibility of pathogens, bacterial resistance needs to be reduced as much as possible.