甘肃省某三甲医院糖尿病足患者创面感染病原菌及相关因素分析

目的探讨甘肃省某三甲医院收治的糖尿病足患者创面感染病原菌情况，分析创面感染的相关因素，为后期临床救治提供理论依据。 方法选择2017年1月至2021年12月甘肃省人民医院收治的符合入选标准的糖尿病足患者，收集并分析患者的人口信息(年龄、性别)、糖尿病足创面特征(糖尿病病程、创面持续时间、创面部位)、抗生素应用数量、实验室检测指标(红细胞计数、白细胞计数、血红蛋白、白蛋白、肌酐、胆固醇、甘油三脂、高密度脂蛋白、低密度脂蛋白、空腹血糖、糖化血红蛋白、白细胞介素-6、降钙素原)、创面细菌培养结果及药物敏感试验结果。数据比较采用χ²检验、单因素分析、多因素Logistic回归分析。 结果(1)本研究共纳入糖尿病足患者173例，其中51~60岁人数最多，有53例，占比30.6%，其次为61~70岁、41~50岁、71~80岁，分别占24.3%、20.2%、16.8%；男性总体多于女性，男性138例，占比79.8%，女性35例，占比20.2%。(2)糖尿病足患者糖尿病病程10~14年人数最多，38例，占比为22.0%，创面持续时间中人数最多为15~30 d，53例，占比为30.1%。173例患者共185个创面，其中位于足趾部位最多，有68例，占比36.8%，其次为足底52例，占比28.1%。(3)患者的实验室检测指标结果显示，红细胞计数低于正常值范围的患者占比60.1%，白细胞计数高于正常值范围的患者占比34.7%，血红蛋白低于正常值范围的患者占比42.8%，白蛋白低于正常值范围的患者占比86.1%，肌酐高于正常值范围的患者占比20.8%，胆固醇高于正常值范围的患者占比11.6%，甘油三酯高于正常值范围的患者占比23.7%，高密度脂蛋白低于正常值范围的患者占比73.4%，低密度脂蛋白高于正常值范围的患者占比12.7%，空腹血糖高于正常值范围的患者占比82.1%，糖化血红蛋白高于正常值范围的患者占比77.5%，白细胞介素-6高于正常值范围的患者占比77.5%，降钙素原高于正常值范围的患者占比68.2%。(4)173例患者共送检标本257份，其中阳性210份，阴性47份，阳性率81.7%；其中革兰阳性菌共120株，占比57.1%，革兰阴性菌共89株，占比42.4%，真菌1株，占比0.5%；革兰阳性菌中金黄色葡萄球菌65株，占比最高，为31.0%，其次是粪肠球菌16株，占比7.6%；革兰阴性菌中阴沟肠杆菌24株，占比最高，为11.4%，其次是大肠埃希菌21株，占比10.0%；药物敏感试验结果显示，金黄色葡萄球菌对甲氧苄啶/磺胺甲恶唑、万古霉素、利奈唑胺等抗生素较为敏感，敏感率均为100.0%；其对青霉素耐药率高，耐药率为89.2%，其次为克林霉素和红霉素，耐药率分别为78.5%、76.9%；阴沟肠杆菌对美洛培南、厄他培南、头孢哌酮/舒巴坦、左旋氧氟沙星等较为敏感，敏感率均为100.0%，其次为阿米卡星、亚胺培南、头孢吡肟，敏感率均为95.8%；大肠埃希菌对美洛培南、厄他培南、亚胺培南、替加环素、头孢西丁、阿米卡星等较为敏感，敏感率均为100.0%。173例患者中，抗生素应用数量为0的有19例，占比11.0%；1种及2种的均有61例，占比均为35.3%；3种的有25例，占比14.4%；4种以上7例，占比4.0%。(5)对糖尿病足患者感染的17个相关因素进行单因素分析，结果显示，创面持续时间、抗生素应用数量、白细胞计数、血红蛋白、白蛋白、高密度脂蛋白、肌酐、糖化血红蛋白、白细胞介素-6、降钙素原等相关因素差异均有统计学意义(P<0.05)；进一步行多因素Logistic回归分析结果显示，与创面感染相关的因素有创面持续时间、抗生素应用数量，高密度脂蛋白(OR＝1.530、1.923、2.587，P<0.05)。 结论糖尿病足患者创面病原菌培养中，革兰阳性菌中以金黄色葡萄球菌、粪肠球菌为主，而革兰阴性菌以阴沟肠杆菌、大肠埃希菌为主；糖尿病足患者感染的独立危险因素为创面形成时间长、抗生素滥用，高密度脂蛋白低。

Analysis of pathogenic bacteria and relevant factors of diabetes foot wound infection in a third-class hospital in Gansu Province

ObjectiveTo investigate the pathogenic bacteria affecting the wound infection of diabetic foot patients in a third-class hospital in Gansu Province, and analyze the relevant factors of wound infection, so as to provide theoretical basis for the later clinical treatment. MethodsThe case data of diabetes foot patients hospitalized in Gansu Provincial People′s Hospital from January 2017 to December 2021 were selected. Demographic information (age, gender), wound characteristics (diabetes course, wound duration, wound site), number of antibiotics applied, laboratory test indicators (red blood cell count, white blood cell count, hemoglobin, albumin, creatinine, cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, blood glucose, glycosylated hemoglobin, interleukin-6 and procalcitonin), wound bacterial culture results and drug sensitivity test results of the patients were collected and analyzed. Data were compared with chi-square test, single factor analysis and the multi-factor Logistic regression analysis. Results(1)A total of 173 patients with diabetic foot were included in this study, of which 53 were in the age group of 51-60, it was the most of them, followed by 61-70 years old, 41-50 years old and 71-80 years old, accounting for 24.3%, 20.2% and 16.8% respectively. There were more men than women, 138 cases of males, accounting for 79.8%, and 35 cases of females, accounting for 20.2%. (2) In diabetic foot patients, the maximum duration of diabetes was 10-14 years (38 cases, accounting for 22.0%), and the maximum duration of wound was 15-30 days (53 cases, accounting for 30.1%). There were 185 wounds in 173 patients, of which the largest number were located in the toe (68 cases, accounting for 36.8%), followed by the sole (52 cases, accounting for 28.1%). (3) Laboratory test indicators results of patients showed that 60.1% of patients had red blood cell count below the normal range, 34.7% had white blood cell count above the normal range, 42.8% had hemoglobin below the normal range, and 86.1% had albumin below the normal range. Patients with creatinine above the normal range accounted for 20.8%, cholesterol above the normal range accounted for 11.6%, triglyceride above the normal range accounted for 23.7%, high density lipoprotein below the normal range accounted for 73.4%, low density lipoprotein above the normal range accounted for 12.7%, blood glucose above the normal range accounted for 82.1%, glycosylated hemoglobin above the normal range accounted for 77.5%, interleukin-6 above the normal range accounted for 77.5%, and procalcitonin above the normal range accounted for 68.2%. (4) A total of 257 samples were collected from 173 patients, of which 210 were positive and 47 were negative, with a positive rate of 81.7%. There were 120 strains of Gram-positive bacteria, accounting for 57.1%, 89 strains of Gram-negative bacteria, accounting for 42.4%, and 1 strain of fungus, accounting for 0.5%. Among Gram-positive bacteria, Staphylococcus aureus accounted for the highest proportion, 65 strains, 31.0%, followed by Enterococcus faecalis, 16 strains, accounting for 7.6%. Among Gram-negative bacteria, Enterobacter cloacae accounted for the highest proportion, 24 strains, 11.4%, followed by Escherichia coli, 21 strains, accounting for 10.0%. The results of drug sensitivity test showed that Staphylococcus aureus wassensitive to trimethoprim/sulfamethoxazole, vancomycin, linezolid and other antibiotics, and the sensitivity rate was 100.0%. The resistance rate to penicillin was 89.2%, followed by clindamycin (78.5%) and erythromycin (76.9%) respectively. Enterobacter cloacae was sensitive to meropenem, ertapenem, cefoperazone/sulbactam and levofloxacin with sensitivity rate of 100.0%, followed by amicacin, imipenem and cefepime with sensitivity rate of 95.8%. Escherichia coli was sensitive to meropenem, ertapenem, imipenem, tigacycline, cefoxitin and Amika magnitude, and the sensitivity rate was 100.0%. Among the 173 patients, 19 cases (11.0%) were treated with non antibiotics; there were 61 cases of 1 and 2 antibiotics, accounting for 35.3%; there were 25 cases of 3 antibiotics, accounting for 14.4%; 7 cases more than 4 antibiotics, accounting for 4.0%. (5) Analysis of 17 factors related to infection in diabetic foot patients showed that there were significant differences in wound duration, number of antibiotics applied, white blood cell count, hemoglobin, albumin, high-density lipoprotein, creatinine, glycosylated hemoglobin, interleukin-6, and procalcitonin (P<0.05). Further Logistic regression analysis showed that the factors related to wound infection were wound duration, antibiotic use and high density lipoprotein (OR=1.530, 1.923, 2.587, P<0.05). ConclusionStaphylococcus aureus and Enterococcus faecalis are the main Gram-positive bacteria, while Enterobacter cloacae and Escherichia coli are the main Gram-negative bacteria in the culture of wound pathogens in patients with diabetes foot; the independent risk factors of infection in patients with diabetes foot were long wound formation time, abuse of antibiotics and low high-density lipoprotein.