CAJ | 학술논문

目的：探讨合并骨髓炎的糖尿病足溃疡（DFO）患者革兰阴性菌（G-）感染的临床特点及其耐药性。方法收集我院91例DFO住院患者的病历资料，根据病原菌的分布特点将其中86例细菌感染的患者分为G-感染组（44例）和革兰阳性菌（G+）感染组（42例），比较2组患者的临床特点，采用非条件Logistic回归分析G-感染的危险因素，并对G-的耐药谱进行总结。结果91例DFO患者包括86例细菌感染者和5例真菌感染者。病原微生物共计112株，其中G-54株（48.2%），G+53株（47.3%），真菌5株（4.5%），G-中以铜绿假单胞菌占首位。G-感染组入院前6个月应用抗生素的比例（75.0%）高于G+感染组（52.4%），2组其他指标比较差异无统计学意义，Logistic回归分析显示，有抗生素应用史是DFO患者感染G-的独立危险因素。药敏结果显示G-对多种头孢类及喹诺酮类抗生素耐药较严重，对亚胺培南、头孢哌酮/舒巴坦、头孢他啶耐药率较低。结论 DFO患者G-感染率高，耐药较普遍，对可疑糖尿病足感染患者应及时行细菌培养与药敏试验，系统合理应用抗生素。
목적：탐토합병골수염적당뇨병족궤양（DFO）환자혁란음성균（G-）감염적림상특점급기내약성。방법수집아원91례DFO주원환자적병력자료，근거병원균적분포특점장기중86례세균감염적환자분위G-감염조（44례）화혁란양성균（G+）감염조（42례），비교2조환자적림상특점，채용비조건Logistic회귀분석G-감염적위험인소，병대G-적내약보진행총결。결과91례DFO환자포괄86례세균감염자화5례진균감염자。병원미생물공계112주，기중G-54주（48.2%），G+53주（47.3%），진균5주（4.5%），G-중이동록가단포균점수위。G-감염조입원전6개월응용항생소적비례（75.0%）고우G+감염조（52.4%），2조기타지표비교차이무통계학의의，Logistic회귀분석현시，유항생소응용사시DFO환자감염G-적독립위험인소。약민결과현시G-대다충두포류급규낙동류항생소내약교엄중，대아알배남、두포고동/서파탄、두포타정내약솔교저。결론 DFO환자G-감염솔고，내약교보편，대가의당뇨병족감염환자응급시행세균배양여약민시험，계통합리응용항생소。
Objective To investigate the clinical features and antibiotic susceptibility of osteomyelitis infected by Gram-negative bacteria (G-) in patients suffered from diabetic foot ulcers (DFU). Methods The clinical data of 91 DFU pa-tients accompanied with osteomyelitis (DFO) were retrospective studied. These patients hospitalized in the Tianjin Metabolic Diseases Hospital were divided into two groups, Gram-negative bacteria (G-) group (n=44) and Gram-positive bacteria (G+) group (n=42), respectively. The clinical features were compared between two groups. Logistic regression analysis was used to determine the risk factors for Gram-negative bactreial infection. The Gram-negative antibiogram was summarized. Results A total of 112 pathogens were isolated from 91 patients. G-bacteria were the most frequent pathogens (48.2%), following by G+ bacteria (47.3%) and fungi (4.5%). Pseudomonas aeruginosa was the majority of the G-bacteria. Comparing the two groups, the rate of antibiotic use within the previous 6 months was significantly higher in G-group (75.0%) than that of G+group (52.4%, P<0.05). There were no significant differences in the other indicators between two groups. The Logistic re-gression analysis revealed that the history of antibiotic use was the independent risk factor of G-bacterial infections in DFO patients. Antibiotics susceptibilities reflected G- bacteria were more prevalent to resist to cephalosporins and quinolonem, but sensitive to imipenem, ceftazidine and cefperazone-sulbactam. Conclusion Gram negative bacteria were not only the main pathogens isolated from DFO patients, but also frequently resistant to several popular antibiotics in China. The proper bacteria culture and antibiotic sensitivity test are especially emphasized to patients with DFU.