糖尿病患者足部感染致病菌分布及耐药性研究

发布时间：2018-04-01 20:25

本文选题：糖尿病　切入点：足部感染　出处：《中华医院感染学杂志》2017年04期

【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(P0.05);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(P0.05)。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。
[Abstract]:Objective to investigate the distribution of pathogenic bacteria and drug resistance of foot infection in patients with diabetes mellitus in hospital, and to provide guidance for clinical treatment. Methods the clinical data of 287 patients with diabetic foot infection from July 2006 to June 2016 were retrospectively analyzed. Results 324 strains of pathogenic bacteria were isolated from 287 patients with diabetic foot infection. Among them, 149 Gram-positive bacteria accounted for 46.0, 153 Gram-negative bacteria accounted for 47.2 and 22 fungi accounted for 6.8. Gram-positive bacteria were mainly Staphylococcus aureus, Enterococcus faecalis, coagulase negative Staphylococcus, Gram-negative bacteria were Escherichia coli and Proteus mirabilis. Pseudomonas aeruginosa was predominant, with the increase of Wagner grade, the pathogenic bacteria changed from Gram-positive bacteria to Gram-negative bacteria, and Staphylococcus continued to be resistant to clindamycin, ampicillin and penicillin in recent 10 years. It is sensitive to amikacin, linazolamine, teicoplanin, vancomycin, etc. The resistance rate of staphylococcus to amoxicillin / clavulanic acid in recent 5 years was 47.8%, which was significantly higher than that in earlier 5 years (12.5%), the difference was statistically significant (P 0.05), and Enterobacteriaceae continued to be highly resistant to ampicillin and imipenem in the last 10 years. Piperacillin / tazobactam, meropenem sensitive, The resistance rate of Enterobacteriaceae to cefotaxime in recent 5 years was 45.5%, which was significantly higher than that in earlier 5 years (28.665.Conclusion from July 2006 to June 2016, Gram-positive bacteria and Gram-negative bacteria in foot infection of diabetic patients were basically equal to those of Gram-negative bacteria. Antimicrobial agents should be reasonably selected according to the distribution and drug resistance of pathogens to avoid the emergence of drug-resistant bacteria.
【作者单位】：河南省人民医院(郑州大学人民医院)内分泌科;
【基金】：河南省科技厅科技攻关计划项目(142102310414)
【分类号】：R587.2

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