摘要
目的分析糖尿病足感染病原学特点及万古霉素联合骨水泥注射治疗效果。方法选取安吉县第三人民医院150例糖尿病足感染患者,根据药敏试验结果与患者病情,128例接受万古霉素联合骨水泥注射治疗(研究组),其余22例予以经验治疗(对照组),分析糖尿病足感染病原学特点,比较两组治疗前后血清炎症因子[白细胞介素-6(IL-6)、IL-17、肿瘤坏死因子-α(TNF-α)]水平,住院时间、治疗1个月完全痊愈率、完全愈合时间及复发情况。结果 150例患者临床共检出病原菌150株,其中革兰阴性菌77株占51.33%,革兰阳性菌73株占48.67%;不同感染程度患者检出病原菌分布比较差异有统计学意义(χ^(2)=16.151,P<0.001),轻度感染患者检出主要为革兰阳性菌(66.18%),并且最多见的是金黄色葡萄球菌(22.06%);中度与重度感染患者主要为革兰阴性菌(62.90%、75.00%),且最多见的是布氏枸橼酸杆菌,占比分别为22.58%、35.00%;两组患者治疗前血清各炎症因子水平比较无显著差异;治疗后两组上述指标均降低,且研究组降低更显著(P<0.05);研究组治疗1个月后痊愈率显著高于对照组(P<0.05),住院时间与创面愈合时间均较对照组缩短(P<0.05)。结论中、重度糖尿病足感染患者以革兰阴性菌感染为主,临床经验治疗需要结合病原菌种类以及药敏试验予以合理调整,其中万古霉素联合骨水泥注射疗法可获得良好疗效。
OBJECTIVE To investigate the etiological characteristics of diabetic foot infection and observe the therapeutic effect of vancomycin combined with bone cement injection.METHODS A total of 150 patients with diabetic foot infection who were treated in the Third People′s Hospital of Anji County were enrolled in the study.According to the result of drug susceptibility testing and illness condition of the patents,128 patients who received vancomycin combined with bone cement injection were assigned as the study group,and the rest of the patients who were given experimental therapy were assigned as the control group.The etiological characteristics of diabetic foot infection were analyzed,the levels of serum inflammatory factors interleukin 6(IL-6),interleukin 17(IL-17)and tumor necrosis factorα(TNF-α)were compared between the two groups of patients before and after the treatment,and the length of hospital stay,complete cure rate,complete healing time and recurrence rate after treatment for 1 month were observed.RESULTS totally 150 strains of pathogens were isolated from the 150 patients,77(51.33%)of which were gram-negative bacteria,73(48.67%)were gram-positive bacteria.There was significant difference in the distribution of pathogens among the patients different degree of infection(χ^(2)=16.151,P<0.001).66.18%of the gram-positive bacteria were isolated from the patients with mild infection,and Staphylococcus aureus(22.06%)was the predominant species;62.90%of the gram-negative bacteria were isolated from the patients with moderate infection,75.00%from the patients with severe infection,and Citrobacter brucei strains were dominant,accounting for 22.58%and 35.00%,respectively.There were no significant differences in the levels of serum inflammatory factors between the two groups of patients before the treatment;the levels of above indexes of the two groups were reduced after the treatment,and the indexes of the study group were significantly lower than those of the control group(P<0.05).The cure rate of the study group was significantly higher than that of the control group after the treatment for 1 month(P<0.05);the length of hospital stay and wound healing time of the study group were significantly shorter than those of the control group(P<0.05).CONCLUSION The gram-negative bacteria are dominant among the patients with moderate and severe diabetic foot infection.The clinical experimental therapy should be carried out based on the species of pathogens and adjusted according to the result of drug susceptibility testing,and vancomycin combined with bone cement injection can achieve favorable curative effect.
作者
孙杰
诸利刚
李宏烨
尤加省
戴龚成
SUN Jie;ZHU Li-gang;LI Hong-ye;YOU Jia-xing;DAI Gong-cheng(The Third Peopled Hospital of Anji County Anji,Zhejiang 313301,China;不详)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2021年第1期24-27,共4页
Chinese Journal of Nosocomiology
基金
浙江省科研基金资助项目(2017AM349)。
关键词
糖尿病足
感染
细菌谱
耐药性
万古霉素
骨水泥
Diabetic foot
Infection
Bacterial spectrum
Drug resistance
Vancomycin
Bone cement
