糖尿病足患者伤口细菌学调查和感染影响因素的分析

发布时间：2018-04-09 05:05

本文选题：糖尿病足　切入点：wagner分级　出处：《天津医科大学》2017年硕士论文

【摘要】：目的了解糖尿病足患者的一般临床情况和伤口分泌物细菌学特点,包括年龄与性别分布、糖尿病病程、伤口特点、wagner分级、实验室指标、下肢血管病变、菌群分布及耐药等情况,分析糖尿病足患者创面感染的影响因素,为临床有效防治感染、合理使用抗菌药物提供参考。方法1、收集2013年1月-2016年12月期间天津市第一中心医院整形与烧伤科收治的103例糖尿病足患者,统计分析患者的性别、年龄、体重指数、血压、糖尿病病程、伤口特点(面积、深度及位置)、wagner分级、实验室指标检测、下肢血管检查、细菌培养及药敏结果等临床资料。2、根据糖尿病足创面感染可能有关的因素,建立数据库,分析创面感染的相关影响因素。3、采用SPSS21.0统计软件对数据进行分析,计数资料以率表示;计量资料以(?±s)表示,对不符合正态分布资料的两个变量是否相关采用非参数法中的等级相关分析,相关程度大小用r表示,对可能的感染影响因素采用Logistic逐一分析,P0.05为差异有统计学意义。结果1、本组共收治糖尿病足患者103例,共采集标本194例,有167例培养出病原菌,检出率86.1%(167/194),共培养得到173株菌株,前4位病原菌为金黄色葡萄球菌17.9%(31/173)、铜绿假单胞菌14.5%(25/173)、表皮葡萄球菌11.6%(20/173)及鲍曼不动杆菌9.3%(16/173)。革兰阳性菌78株,占45.1%(78/173);革兰阴性菌92株,占53.2%(92/173);真菌3株,占1.7%(3/173)。革兰阳性菌最常见的是金黄色葡萄球菌,占39.7%(31/78),其次为表皮葡萄球菌,占25.6%(20/78)。革兰阴性菌最常见的铜绿假单胞菌,占27.2%(25/92),其次为鲍曼不动杆菌,占17.4%(16/92)。2、金黄色葡萄球菌对万古霉素和利奈唑胺敏感率分别为100.0%(31/31)和83.9%(26/31);表皮葡萄球菌对万古霉素和替加环素敏感率分别为100.0%(20/20)和85.0%(17/20)。铜绿假单胞菌对亚胺培南和美罗培南敏感率分别为72.0%(18/25)和84.0%(21/25);鲍曼不动杆菌对阿米卡星、亚胺培南及美罗培南敏感率分别为75.0%(12/16)、81.3%(13/16)及81.3%(13/16)。3、糖尿病足伤口感染可能的的影响因素Logistic回归分析结果显示,糖尿病足伤口感染的前5个影响因素分别是低蛋白血症(OR=6.172,P=0.001)、下肢血管病变(OR=3.741,P=0.004)、合并糖尿病肾病(OR=2.685,P=0.002)、糖尿病病程(OR=2.324,P=0.004)及糖化血红蛋白升高(OR=1.216,P=0.005)。结论1、103例糖尿病足患者伤口病原菌检出率为86.08%,前4位病原菌为金黄色葡萄球菌、铜绿假单胞菌、表皮葡萄球菌及鲍曼不动杆菌,分别占17.9%、14.5%、11.6%及9.3%。革兰阳性菌占45.1%,前2位病原菌为金黄色葡萄球菌39.7%和表皮葡萄球菌25.6%;革兰阴性菌占53.2%,前2位为铜绿假单胞菌27.2%和鲍曼不动杆菌17.4%。2、金黄色葡萄球菌对万古霉素和利奈唑胺敏感率分别为100.0%和83.9%;表皮葡萄球菌对万古霉素和替加环素敏感率分别为100.0%和85.0%。铜绿假单胞菌对亚胺培南和美罗培南敏感率分别为72.0%和84.0%;鲍曼不动杆菌对阿米卡星、亚胺培南及美罗培南敏感率分别为75.0%、81.3%及81.3%。3、糖尿病足伤口感染的前5个影响因素根据相对危险度(OR)值的大小依次为低蛋白血症(6.172)、下肢血管病变(3.741)、合并糖尿病肾病(2.685)、糖尿病病程(2.324)及糖化血红蛋白升高(1.216)。
[Abstract]:Objective to understand the clinical situation of patients with diabetic foot wound secretion and bacteriological characteristics, including age and gender distribution, duration of diabetes, wound characteristics, Wagner classification, laboratory index, lower extremity vascular disease, bacterial distribution and drug-resistance analysis, factors affecting wound in patients with diabetic foot infection, for the effective prevention and treatment of infection, to provide a reasonable reference the use of antimicrobial drugs. Methods 1, from January 2013 -2016 year in December in Tianjin First Central Hospital of plastic and burn department treated 103 cases of patients with diabetic foot, statistical analysis of patients with gender, age, body mass index, blood pressure, diabetes duration, wound characteristics (size, depth and location), Wagner classification, laboratory test, examination of lower extremity vascular. Bacterial culture and drug sensitivity results and clinical information of.2, establish the database according to the factors related to diabetic foot wound infection of wound .3 infection related factors, the data were analyzed using SPSS21.0 statistical software, count data expressed as a ratio; measurement data to (? + s) said that the two variables do not conform to the normal distribution of data is related to the use of non parametric rank correlation analysis method, correlation degree by R, using Logistic one by one analysis of the possible impact factors of infection in P0.05, the difference was statistically significant. The results of the 1 groups were treated 103 cases of diabetic foot patients were collected in 194 cases, 167 cases of cultured pathogenic bacteria, the detection rate of 86.1% (167/194), 173 strains were cultured, the top 4 pathogens were Staphylococcus aureus (31/173 17.9%), Pseudomonas aeruginosa (25/173 14.5%), Staphylococcus epidermidis (20/173 11.6%) and Bauman Acinetobacter (16/173) 9.3%. 78 strains of gram positive bacteria accounted for 45.1% (78/173); 92 strains of gram negative bacteria accounted for 53.2% (92/173); 3 strains of fungi. 3/1 (accounting for 1.7% 73) leather. The most common gram positive cocci were Staphylococcus aureus, 39.7% (31/78), followed by Staphylococcus epidermidis, accounted for 25.6% (20/78). Pseudomonas aeruginosa is the most common gram negative bacilli, accounting for 27.2% (25/92), followed by Bauman Acinetobacter, accounting for 17.4% (16/92).2, Staphylococcus aureus were 100% of vancomycin and linezolid sensitivity rate (31/31) and 83.9% (26/31); Staphylococcus aureus to vancomycin and tigecycline susceptibility rate were 100% (20/20) and 85% (17/20). Pseudomonas aeruginosa were 72% sensitive to imipenem and Luo Peinan rate (18/25) and 84% (21/25); Bauman Acinetobacter to Amikacin, imipenem and meropenem sensitive rates were 75% (12/16), 81.3% (13/16) and 81.3%.3 (13/16), diabetic foot wound infection may be the influencing factors Logistic regression analysis showed that diabetes before 5 foot wound infection The influence factors were hypoproteinemia (OR=6.172, P=0.001), lower extremity vascular disease (OR=3.741, P=0.004), diabetic nephropathy (OR=2.685, P=0.002), diabetes (OR=2.324, P=0.004) and elevated glycated hemoglobin (OR=1.216, P=0.005). Conclusion: 1103 cases of patients with diabetic foot wound pathogen detection rate was 86.08%, 4 pathogenic bacteria were Staphylococcus aureus, Pseudomonas aeruginosa, Staphylococcus aureus and epidermal Bauman Acinetobacter, respectively 17.9%, 14.5%, 11.6% and 9.3%. gram positive bacteria accounted for 45.1%, the top 2 pathogens were Staphylococcus aureus 39.7% and Staphylococcus epidermidis 25.6%; gram negative bacteria accounted for 53.2%, before 2 to 27.2% of Pseudomonas aeruginosa and Acinetobacter Bauman 17.4%.2, Staphylococcus aureus were 100% and 83.9% for vancomycin and linezolid susceptibility; Staphylococcus epidermidis to vancomycin and tigecycline susceptibility rate were 100% 85.0%. and Pseudomonas aeruginosa were 72% and 84% for imipenem and meropenem susceptibility; Bauman Acinetobacter to Amikacin, imipenem and meropenem sensitivity rates were 75%, 81.3% and 81.3%.3, 5 diabetic foot wound infection factors according to the relative risk (OR) value as follows hypoproteinemia (6.172), lower extremity vascular disease (3.741), diabetic nephropathy (2.685), diabetes (2.324) and elevated glycated hemoglobin (1.216).

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2

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