糖尿病足溃疡与感染患者病原菌分布与合理抗菌药物的选用分析
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摘要
目的结合糖尿病足感染与溃疡分级探讨病原菌分布及耐药性特征,以指导临床合理使用抗菌药物。方法对2014年8月-2017年7月某院内分泌科糖尿病足129例患者临床资料、创面分泌物分离病原菌以及药敏试验结果进行回顾性分析。结果糖尿病足溃疡以Wagner2-4级为主,分别占29.5%、24.8%、28.7%;糖尿病足感染以轻、中度为主,分别占41.1%和38.8%。轻度感染组病原菌以革兰阳性球菌为主(24.0%),金黄色葡萄球菌(7.8%)最为多见。中、重度感染病原菌以革兰阴性杆菌为主(24.0%和5.4%),布氏枸橼酸杆菌多见(8.5%和3.1%)。革兰阳性球菌敏感抗菌药物主要为万古霉素、利奈唑胺、替考拉宁等。革兰阴性杆菌敏感抗菌药物主要为亚胺培南、美洛培南、哌拉西林/他唑巴坦等。多重耐药菌主要为耐甲氧西林金黄色葡萄球菌9株(34.6%)和大肠埃希菌(ESBL阳性)7株(26.9%)。结论糖尿病足溃疡感染的病原菌谱随着感染程度加重表现为从革兰阳性球菌转变为以革兰阴性杆菌为主,其经验治疗应根据病原菌种类与药敏试验结果合理调整。
Objective The aim of this study was to analyze the infectious characteristics of DFU(diabetic foot ulcer) and the distribution of pathogens causing DFU to improve the rational antibiotic treatment.Methods A retrospective study was conducted on the pathogens detected from the wound secretions of DFU patients from August 2014 to July 2017.The pathogens were isolated and cultured with the drug susceptibility test.Results Wagner grades 2-4 took 29.5%,24.8% and28.7% of the DFU patients,respectively.The percentage of mild infection was 41.1%,which was more than that of mid-grade group(38.8%) in the DFU patients(χ2=6.63,P<0.05).Gram positive cocci were the main pathogens in mild infection(24%),of which 7.8% was staphylococcus aureus.Gram negative bacilli were the main pathogenic bacteria of moderate and severe infection(24.0% and 5.4%,respectively),and Acidobacteria was the most common one(8.5% and 3.1%,respectively)in those groups.Sensitive antibiotics to Gram positive cocci included vancomycin,linezolid,teicoplanin,meropenem,and imipenem,while sensitive to meropenem,imipenem,piperacillin/tazobactam,and amoxicillin/clavulanic acid.There were 9 strains of MRSA(34.6%) and 7 strains of Escherichia coli(ESBL-positive)(26.9%) in the isolated multidrug-resistant bacteria with an increase both in Wagner degrees and levelled infections.Conclusion Pathogenic bacteria spectrum changed from Gram positive cocci to Gram negative bacilli when infection was aggravated.Thereby,the antibiotics could be empirically selected in accordance with the bacteria spectrum and bacterial susceptibility testing.
Objective The aim of this study was to analyze the infectious characteristics of DFU(diabetic foot ulcer) and the distribution of pathogens causing DFU to improve the rational antibiotic treatment.Methods A retrospective study was conducted on the pathogens detected from the wound secretions of DFU patients from August 2014 to July 2017.The pathogens were isolated and cultured with the drug susceptibility test.Results Wagner grades 2-4 took 29.5%,24.8% and28.7% of the DFU patients,respectively.The percentage of mild infection was 41.1%,which was more than that of mid-grade group(38.8%) in the DFU patients(χ2=6.63,P<0.05).Gram positive cocci were the main pathogens in mild infection(24%),of which 7.8% was staphylococcus aureus.Gram negative bacilli were the main pathogenic bacteria of moderate and severe infection(24.0% and 5.4%,respectively),and Acidobacteria was the most common one(8.5% and 3.1%,respectively)in those groups.Sensitive antibiotics to Gram positive cocci included vancomycin,linezolid,teicoplanin,meropenem,and imipenem,while sensitive to meropenem,imipenem,piperacillin/tazobactam,and amoxicillin/clavulanic acid.There were 9 strains of MRSA(34.6%) and 7 strains of Escherichia coli(ESBL-positive)(26.9%) in the isolated multidrug-resistant bacteria with an increase both in Wagner degrees and levelled infections.Conclusion Pathogenic bacteria spectrum changed from Gram positive cocci to Gram negative bacilli when infection was aggravated.Thereby,the antibiotics could be empirically selected in accordance with the bacteria spectrum and bacterial susceptibility testing.
引文
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[4]姜昆,李春辉,黄勋.糖尿病患者足感染治疗指南(选摘)[J].继续医学教育,2007,21(5):36-39.
[5]邹树芳,杨容琼,徐芬.糖尿病足的危险因素与预防[J].现代预防医学,2010,37(21):4167-4168.
[6]Apelqvist J,Bakker K,Van Houtum WH,et al.International consensus and practical guidelines on the management and the prevention of the diabetic foot.International Working Group on the Diabetic Foot[J].Diabetes-Metabolism:Research and Reviews,2000,16(Suppl 1):S84-S92.
[7]Wagner FW.The dysvascular foot:a system for diagnosis and treatment[J].Foot&Ankle,1981,2(2):64-122.
[8]李惠琴,苏晓飞,丁波,等.218例糖尿病足患者临床特征及高危因素分析[J].中华内分泌代谢杂志,2012,28(6):492-495.
[9]徐波,杨彩哲,刘朝阳,等.糖尿病足感染患者病原菌分布及其药物敏感试验[J].中华传染病杂志,2016,34(6):344-348.
[10]沈秋燕,林迪妮,朱虹,等.糖尿病足合并感染患者754株病原菌分布及耐药性分析[J].中华医学杂志,2014,94(12):889-894.
[11]Dinh T,Snyder G,Veves A.Current techniques to detect foot infection in the diabetic patient[J].The International Journal of Lower Extremity Wounds,2010,9(1):24-30.
[12]Shah BR,Hux JE.Quantifying the risk of infectious diseases for People with diabetes[J].Diabetes Care,2003,26(2):510-513.
[13]吴月平,何书连,宋钦华.57例糖尿病足患者的临床分析[J].现代预防医学,2011,38(15):3156,3160.
[14]Chen SY,Giurini JM,Karchmer AW.Invasive systemic infection after hospital treatment for diabetic foot ulcer:risk of occurrence and effect on survival[J].Clinical Infectious Diseases:an Official Publication of the Infectious Diseases Society of America,2017,64(3):326-334.
[15]于桂青.引起糖尿病足患者多重耐药菌感染的病例对照分析[J].现代预防医学,2014,41(16):2902-2904,2913.
[2]Pickwell K,Siersma V,Kars M,et al.Predictors of lower-extremity amputation in patients with an infected diabetic foot ulcer[J].Diabetes Care,2015,38(5):852-857.
[3]莫泽纬,高勇义.糖尿病足患者死亡的相关危险因素[J].现代预防医学,2013,40(23):4434-4436.
[4]姜昆,李春辉,黄勋.糖尿病患者足感染治疗指南(选摘)[J].继续医学教育,2007,21(5):36-39.
[5]邹树芳,杨容琼,徐芬.糖尿病足的危险因素与预防[J].现代预防医学,2010,37(21):4167-4168.
[6]Apelqvist J,Bakker K,Van Houtum WH,et al.International consensus and practical guidelines on the management and the prevention of the diabetic foot.International Working Group on the Diabetic Foot[J].Diabetes-Metabolism:Research and Reviews,2000,16(Suppl 1):S84-S92.
[7]Wagner FW.The dysvascular foot:a system for diagnosis and treatment[J].Foot&Ankle,1981,2(2):64-122.
[8]李惠琴,苏晓飞,丁波,等.218例糖尿病足患者临床特征及高危因素分析[J].中华内分泌代谢杂志,2012,28(6):492-495.
[9]徐波,杨彩哲,刘朝阳,等.糖尿病足感染患者病原菌分布及其药物敏感试验[J].中华传染病杂志,2016,34(6):344-348.
[10]沈秋燕,林迪妮,朱虹,等.糖尿病足合并感染患者754株病原菌分布及耐药性分析[J].中华医学杂志,2014,94(12):889-894.
[11]Dinh T,Snyder G,Veves A.Current techniques to detect foot infection in the diabetic patient[J].The International Journal of Lower Extremity Wounds,2010,9(1):24-30.
[12]Shah BR,Hux JE.Quantifying the risk of infectious diseases for People with diabetes[J].Diabetes Care,2003,26(2):510-513.
[13]吴月平,何书连,宋钦华.57例糖尿病足患者的临床分析[J].现代预防医学,2011,38(15):3156,3160.
[14]Chen SY,Giurini JM,Karchmer AW.Invasive systemic infection after hospital treatment for diabetic foot ulcer:risk of occurrence and effect on survival[J].Clinical Infectious Diseases:an Official Publication of the Infectious Diseases Society of America,2017,64(3):326-334.
[15]于桂青.引起糖尿病足患者多重耐药菌感染的病例对照分析[J].现代预防医学,2014,41(16):2902-2904,2913.