摘要
目的探讨医院糖尿病患者足部感染病原菌分布及耐药性,为临床治疗提供一定指导价值。方法回顾性分析2006年7月-2016年6月糖尿病足部感染患者287例的临床资料,统计糖尿病患者足部感染病原菌分布及耐药性。结果 287例糖尿病足部感染患者共分离出病原菌324株,其中革兰阳性菌149株占46.0%,革兰阴性菌153株占47.2%,真菌22株占6.8%;革兰阳性菌以金黄色葡萄球菌、粪肠球菌、凝固酶阴性葡萄球菌为主;革兰阴性菌以大肠埃希菌、奇异变形菌、铜绿假单胞菌为主;伴随着Wagner分级的增加,感染病原菌由以革兰阳性菌为主逐渐转变为以革兰阴性菌为主;近10年葡萄球菌属对克林霉素、氨苄西林、青霉素持续耐药,对阿米卡星、利奈唑胺、替考拉宁、万古霉素等敏感;近5年葡萄球菌属对阿莫西林/克拉维酸的耐药率为47.8%显著高于早先5年的耐药率12.5%,差异有统计学意义(P<0.05);近10年肠杆菌科对氨苄西林持续高度耐药,对亚胺培南、哌拉西林/他唑巴坦、美罗培南敏感,近5年肠杆菌科对头孢噻肟的耐药率为45.5%显著高于早先5年的耐药率28.6%,差异有统计学意义(P<0.05)。结论 2006年7月-2016年6月糖尿病患者足部感染革兰阳性菌与革兰阴性菌基本持平,耐药状况普遍,应根据病原菌分布与耐药性合理选择抗菌药物,避免耐药菌的产生。
OBJECTIVE To explore the pathogenic bacteria distribution and drug resistance in patients with diabetic foot,so as to provide some guidance for its clinical treatment.METHODS The clinical data of 287 patients with diabetic foot from Jul.2006 to Jun.2016 were retrospectively analyzed.The pathogenic bacteria distribution and drug resistance of foot infection in diabetic patients were analyzed.RESULTS A total of 324 strains of bacteria were isolated from 287 cases of patients with diabetic foot,including 149 strains of gram-positive bacteria accounted for 46%,153 strains of gram-negative bacteria accounted for 47.2%,and 22 strains of fungi accounting for6.8%.Gram-positive bacteria were mainly Staphylococcus aureus,Enterococcus faecalis and coagulase negative Staphylococci,gram-negative bacteria were mainly Escherichia coli,Proteus mirabilis,and Pseudomonas aeruginosa.With the increase of Wagner grade,the main pathogenic bacteria gradually changed from gram-positive bacteria to gram-negative bacteria.Over the past 10 years,Staphylococcus was resistant to clindamycin,ampicillin,and penicillin,and was sensitive to amikacin,linezolid,teicoplanin,and vancomycin.The resistant rate of Staphylococcus to amoxicillin/clavulanic acid was 47.8%in the past 5years,which was significantly higher than 12.5%in the previous 5years,and the difference was statistically significant（P〈0.05）.In recent 10 years,Enterobacteriaceae was highly resistant to ampicillin and was sensitive to imipenem,piperacillin/tazobactam and meropenem.In recent 5years,the resistant rate of Enterobacteriaceae to cefotaxime was 45.5%,which was significantly higher than 28.6% of the previous 5 years,and the difference was statistically significant（P〈0.05）.CONCLUSION.Gram-positive bacteria and gram-negative bacteria were almost the same in foot infection in patients with diabetes mellitus in the past 10 years,and the status of drug resistance was common.It should rationally choose antibiotics based on pathogen distribution and drug resistance,to avoid the emergency of drug-resistant bacteria
作者
韦伟
刘宏霞
汤莎莎
邓欣如
李莉
吕英华
袁慧娟
WEI Wei LIU Hong-xia TANG Sha-sha DENG Xin-ru LI Li LV Ying-hua YUAN Hui-Juan(Henan Provincial People ls Hospital, Zhengzhou, Henan 450003, Chin)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2017年第4期819-822,共4页
Chinese Journal of Nosocomiology
基金
河南省科技厅科技攻关计划项目(142102310414)
关键词
糖尿病
足部感染
致病菌
耐药性
Diabetes mellitus
Foot infection
Pathogenic bacteria
Drug resistance
