摘要
目的探讨合并骨髓炎的糖尿病足感染病原菌分布、耐药性特点及其危险因素。方法收集我院2011年1月~2014年12月372例糖尿病足感染住院患者的病历资料,根据有无合并骨髓炎分为有骨髓炎（OM）组（54.6%）及无骨髓炎组（Non-OM）组（45.4%）,比较组间创面感染病原菌分布及耐药性特点,用Logistic回归分析发生骨髓炎的危险因素。结果 OM组以革兰阴性（G-）菌感染为主（53.7%）,而Non-OM组以革兰阳性菌（G＋）菌感染占优势（56.7%）（P=0.001）。G＋菌以葡萄球菌属最常见（35.1%）,OM组中葡萄球菌对苯唑西林、头孢西丁的耐药率（64.9%、68.5%）显著高于Non-OM组（29.2%、32.6%）（P〈0.05）。G-菌以肠杆菌为主（62.4%）,OM组中肠杆菌对头孢吡肟、氨曲南的耐药率（30.1%、38.6%）显著高于Non-OM组（15.1%、22.2%）（P〈0.05）。Logistic回归分析显示多重耐药菌感染及创面大于4 cm2是糖尿病足患者发生骨髓炎的危险因素（P〈0.05）。结论对糖尿病足合并骨髓炎患者经验性抗感染治疗时,可根据创面病原菌分布及耐药性特征选择覆盖G-菌的抗生素,对于感染多重耐药菌及伤口面积〉4 cm2的患者应警惕骨髓炎的发生。
Objective To explore the distribution and antibiotic resistance of pathogens in lesions of diabetic foot osteomyelitis（DFO） and analyze the risk factors causing osteomyelitis. Methods A total of 372 patients with diabetic foot infections hospitalized between January 2011 and December 2014, including 203 with osteomyelitis（OM group） and 169 without osteomyelitis（non- OM group）, were examined for the distribution and antibiotic resistance profile of the pathogens in the wounds. Logistic regression analysis was used to analyze the risk factors causing osteomyelitis. Results Gram- negative bacteria were the predominant pathogens（53.7%） in the infected wounds in OM group, whereas Gram-positive bacteria were the most frequently found（56.7%） in non- OM group（P=0.001）. Among the Gram- positive bacteria, Staphylococcus was the dominating flora（35.1%）. The resistance rate to oxacillin and cefoxitin of the isolated bacteria in OM group（64.9% and 68.5%,respectively） was significantly higher than that in non- OM group（29.2% and 32.6%, respectively; P〈0.05）. Among the gramnegative bacteria, Enterobacteriaceae was the dominating flora（62.4%）, with a higher resistance rate to Cefepime and Aztreonam in OM group（30.1% and 38.6%, respectively） than in non- OM group（15.1% and 22.2%, respectively; P〈0.05）. Logistic regression analysis indicated that the infection by multi- drug resistant bacteria and an wounds area 4 cm2 were the risk factors for osteomyelitis in patients with diabetic foot infections（P〈0.05）. Conclusions In addition to an empirical antiinfection therapy, clinicians should choose specific antibiotics against Gram- negative bacteria according to the microbial spectrum and antibiotic resistance of pathogens in patients with DFO; patients with diabetic foot infections by multi- drug resistant bacteria and those with a wound area exceeding 4 cm2 are exposed to an increased risk of osteomyelitis.
出处
《南方医科大学学报》
CAS
CSCD
北大核心
2015年第12期1782-1786,共5页
Journal of Southern Medical University
基金
广东省科技计划项目(2013B022000063)
关键词
糖尿病足
骨髓炎
病原菌
危险因素
diabetic foot
osteomyelitis
pathogenic bacteria
risk factors
