CAJ | 학술논문

目的了解糖尿病足溃疡处病原菌分布及耐药情况.方法回顾性分析2010年1月-2013年8月在温州医科大学附属第一医院住院治疗,有临床标本的糖尿病足患者519例,对其创面处分离的754株病原菌进行病原菌分布及耐药性分析.结果 519例患者中444例(85.5％)分离出病原菌共754株,包括革兰阳性(G+)菌357株(47.3％),革兰阴性(G-)菌304株(40.3％),真菌93株(12.3％).随着溃疡Wagner级别的增加,病原菌谱由以G+菌为主逐渐转变为以G-菌为主,且真菌及混合感染率逐渐升高,以G+菌与G-菌混合感染为主.多重耐药菌(MDRO) 122株(16.2％).G+菌以金黄色葡萄球菌、表皮葡萄球菌及粪肠球菌为主.葡萄球菌属对青霉素G、红霉素、苯唑西林耐药率较高,对万古霉素、利奈唑胺则较敏感;G-菌以肠杆菌科为主,主要有大肠埃希菌、变形杆菌属,分离出铜绿假单胞菌29株;肠杆菌科对美罗培南、亚胺培南、哌拉西林/他唑巴坦、舒普深及头孢吡肟的耐药性较低,其他抗菌药物有不同程度耐药.真菌以白色念珠菌为主.结论病情重的糖尿病足感染,病原菌以G-菌为主,且真菌及混合感染比例升高.万古霉素、亚胺培南抗菌活性较高,但耐药形势仍严峻,应合理使用抗生素,注意监测细菌耐药性.
목적 료해당뇨병족궤양처병원균분포급내약정황.방법 회고성분석2010년1월-2013년8월재온주의과대학부속제일의원주원치료,유림상표본적당뇨병족환자519례,대기창면처분리적754주병원균진행병원균분포급내약성분석.결과 519례환자중444례(85.5％)분리출병원균공754주,포괄혁란양성(G+)균357주(47.3％),혁란음성(G-)균304주(40.3％),진균93주(12.3％).수착궤양Wagner급별적증가,병원균보유이G+균위주축점전변위이G-균위주,차진균급혼합감염솔축점승고,이G+균여G-균혼합감염위주.다중내약균(MDRO) 122주(16.2％).G+균이금황색포도구균、표피포도구균급분장구균위주.포도구균속대청매소G、홍매소、분서서림내약솔교고,대만고매소、리내서알칙교민감;G-균이장간균과위주,주요유대장애희균、변형간균속,분리출동록가단포균29주;장간균과대미라배남、아알배남、고랍서림/타서파탄、서보심급두포필우적내약성교저,기타항균약물유불동정도내약.진균이백색념주균위주.결론 병정중적당뇨병족감염,병원균이G-균위주,차진균급혼합감염비례승고.만고매소、아알배남항균활성교고,단내약형세잉엄준,응합리사용항생소,주의감측세균내약성.
Objective To explore the microbiological profiles and antibiotic susceptibility patterns of organisms isolated from diabetic foot ulcers so as to provide selection rationales of antibiotics.Methods A retrospective study was conducted on the microbiological profiles and antibiotic susceptibilities in 754 strains of pathogens isolated from 519 patients with diabetic foot ulcers at our hospital from January 2010 to August 2013.The inter-group data were compared by Chi-square test.Results There were 322 (62.0％)males and 197 (38.0％) females.Their mean age was (67.7 ± 12.3) (30-93) years,duration of diabetes 10 (0-40) years,duration of lower-limb lesion 1.0 (0.0-72.0) months and HbA1c (9.09％ ± 2.28％).Among 444 (85.5％) cases,a total of 754 strains of pathogens were isolated.Gram-positive aerobes were the most frequently isolated (47.3％,357 strains) and followed by gram-negative aerobes and fungus (40.3％ vs 12.3％,304 vs 93 strains respectively).With rising Wagner's grades,bacterial floras transformed from Gram-positive cocci to Gram-negative rods while fungus and composite infections increased.And 122 strains were of multi drug resistant organisms (MDRO).Among 357 strains of Gram-positive bacteria,Staphylococcus aureus,Staphylococcus epidermidis and Enterococcus faecalis were dominating floras.Staphylococcus was highly resistant to penicillin G,erythromycin,and oxacillin while vancomycin and linezolid were the most effective agents against gram-positive bacteria.Among 304 strains of gram-negative bacteria,enterobacteria were the most prevalent,including 48 strains of Escherichia coli,34 strains of Proteus mirabilis and 31 strains of Proteus vulgaris.And there were 29 strains of Pseudomonas aeruginosa.Enterobacteria were highly resistant to ampicillin,followed by bactrim and furadantin while meropenem,imipenem,piperacillin/sulbactam,sulperazone and cefepime were the most effective agents.The predominant fungus was Blastomyces albicans.Conclusions In patients with severe diabetic foot ulcers,Gram-negative rods predominate while the prevalence of fungus and composite infections increases.Vancomycin and imipenem maintain highly antibacterial activity.It is essential to pay attention to pathogen survey and use antibiotics more rationally.