CAJ | 학술논문

目的观察糖尿病足(DF)患者感染病原菌的分布特点,并探讨DF患者感染耐甲氧西林金黄色葡萄球菌( MRSA)、耐甲氧西林表皮葡萄球菌(MRSE)的危险因素.方法收集2008年1月至2010年6月天津医科大学代谢病医院388例DF溃疡住院患者的临床资料,分析感染病原菌的分布特点,将感染金黄色葡萄球菌的患者分为MRSA组和甲氧西林敏感金黄色葡萄球菌(MSSA)组,感染表皮葡萄球菌的患者分为MRSE组和甲氧西林敏感表皮葡萄球菌(MSSE)组,分别对比分析前两组和后两组患者的临床特点,采用非条件Logistic回归分析DF感染MRSA、MRSE的危险因素.结果 388例DF患者共分离出362株病原体,以G+菌为主,共207株(57.2％),G-杆菌142株(39.2％),真菌13例(3.6％).最常分离的前3种病原菌为金黄色葡萄球菌(27.1％,98/362)、表皮葡萄球菌(18.8％,68/362)、绿脓杆菌(15.5％,56/362).单因素分析中,MRSA组与MSSA组患者比较,在入院前6个月内应用抗生素、溃疡程度(面积、深浅)、骨髓炎、高血压、贫血、低蛋白血症、红细胞沉降率方面差异有统计学意义(P＜0.05)；MRSE与MSSE组患者比较,在溃疡是否复发,合并骨髓炎、低蛋白血症、糖化血红蛋白、血清总蛋白方面差异有统计学意义(P＜0.05).非条件Logistic回归分析显示,入院前6个月内应用抗生素、溃疡病程、骨髓炎、高血压、低蛋白血症是DF患者感染MRSA的危险因素.糖化血红蛋白是DF患者感染MRSE的危险因素.结论 DF患者感染的病原菌以G+球菌为主；DF患者感染MRSA的相关危险因素为溃疡病程长、合并骨髓炎、高血压、低蛋白血症、入院前6个月内应用抗生素:糖化血红蛋白是DF感染MRSE的独立危险因素.
목적 관찰당뇨병족(DF)환자감염병원균적분포특점,병탐토DF환자감염내갑양서림금황색포도구균( MRSA)、내갑양서림표피포도구균(MRSE)적위험인소.방법 수집2008년1월지2010년6월천진의과대학대사병의원388례DF궤양주원환자적림상자료,분석감염병원균적분포특점,장감염금황색포도구균적환자분위MRSA조화갑양서림민감금황색포도구균(MSSA)조,감염표피포도구균적환자분위MRSE조화갑양서림민감표피포도구균(MSSE)조,분별대비분석전량조화후량조환자적림상특점,채용비조건Logistic회귀분석DF감염MRSA、MRSE적위험인소.결과 388례DF환자공분리출362주병원체,이G+균위주,공207주(57.2％),G-간균142주(39.2％),진균13례(3.6％).최상분리적전3충병원균위금황색포도구균(27.1％,98/362)、표피포도구균(18.8％,68/362)、록농간균(15.5％,56/362).단인소분석중,MRSA조여MSSA조환자비교,재입원전6개월내응용항생소、궤양정도(면적、심천)、골수염、고혈압、빈혈、저단백혈증、홍세포침강솔방면차이유통계학의의(P＜0.05)；MRSE여MSSE조환자비교,재궤양시부복발,합병골수염、저단백혈증、당화혈홍단백、혈청총단백방면차이유통계학의의(P＜0.05).비조건Logistic회귀분석현시,입원전6개월내응용항생소、궤양병정、골수염、고혈압、저단백혈증시DF환자감염MRSA적위험인소.당화혈홍단백시DF환자감염MRSE적위험인소.결론 DF환자감염적병원균이G+구균위주；DF환자감염MRSA적상관위험인소위궤양병정장、합병골수염、고혈압、저단백혈증、입원전6개월내응용항생소:당화혈홍단백시DF감염MRSE적독립위험인소.
Objective To examine the distribution patterns of pathogens isolated from the patients with diabetic foot ulcers and explore the risk factors for infections of methicillin-resistant S.aureus (MRSA)or methicillin-resistant S.epidermidis (MRSE).Methods A total of 388 diabetic-foot patients hospitalized at Tianjin Metabolic Diseases Hospital between January 2008 and June 2010 were recruited.The distribution profiles of pathogens isolated from diabetic foot ulcers were summarized. The patients with S. aureus infections were divided into MRSA and MSSA groups while those with S.epidermidis infections into MRSE and MSSE groups. The clinical features of these patients were compared between all groups. Logistic regression was employed to identify the risk factors for the MRSA/MRSE infections.Results A total of 362 pathogens were isolated from them.And the Gram-positive bacteria were the most predominant (57.2％,207/362),followed by Gram-negative bacilli (39.2％,142/362 ) and true fungi ( 3.6％,13/362 ).The three most frequently isolated pathogens were S. aureus ( 27.1％ ),S. epidermidis ( 18.8％ ) and Pseudomonas aeruginosa (15.5％). Statistically significant differences existed in antibiotic usage in 6 months prior to hospitalization,course of ulcer,ulcer size,deep ulcer,osteomyelitis,hypertension,anemia,hypoproteinemia and erythrocyte sedimentation rate between the patients infected with MRSA and MSSA (P ＜ 0.05 ). The MRSE infection was correlated with recurrent ulcer, osteomyelitis,hypoproteinemia,HbA1c and lower total serum protein (P ＜0.05).Multiple Logistic regression analysis revealed that antibiotic usage in 6 months prior to hospitalization,long course of ulcer,osteomyelitis,hypertension and hypoproteinemia were risk factors for the MRSA infection.And HbA1c was a risk factor for the MRSE infection.Conclusion In the present study,the Gram-positive cocci are the main pathogens isolated from diabetic foot ulcers. And S. aureus and S. epidermidis are the most frequently isolated pathogens.Antibiotic usage in 6 months prior to hospitalization,long course of ulcer,osteomyelitis,hypertension and hypoproteinemia are risk factors for the MRSA infection.And HbA1c is a risk factor for the MRSE infection.