糖尿病足湿性坏疽多重耐药菌耐药特点分析

目的探讨糖尿病足湿性坏疽多重耐药菌的分布特点及耐药情况。方法选择2010年1月至2014年12月该院脉管炎科及糖尿病科送检的糖尿病足湿性坏疽患者分泌物1 845份,分离多重耐药菌,分析其分布情况及革兰阴性菌、革兰阳性菌、厌氧菌、真菌的多重耐药特点。结果分离出465株多重耐药菌株中,革兰阴性杆菌274株(58.92%),革兰阳性球菌191株(41.08%)。革兰阴性多重耐药菌株中以大肠埃希菌株为主占37.60%,革兰阳性多重耐药菌株中以凝固酶阴性葡萄球菌为主占51.30%;多重耐药阴性杆菌中,产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌及肺炎克雷伯菌、鲍曼溶血不动杆菌、铜绿假单胞菌表现高耐药性,耐药率达到50.00%以上;多重耐药阳性球菌中,凝固酶阴性葡萄球菌及金黄色葡萄球菌均为耐甲氧西林阳性菌株,这些菌株表现高耐药性,耐药率达85.00%以上。结论糖尿病足湿性坏疽多重耐药菌中大肠埃希菌、肺炎克雷伯菌、凝固酶阴性葡萄球菌及金黄色葡萄球菌表现高耐药性,临床应结合耐药鉴定分析选择用药。

Analysis on drug resistance characteristics of multi-drug resistant bacteria in diabetic feet with moist gangrene

Objective To investigate the distribution characteristics and drug resistance situation of multi-drug resistant bacteria in diabetic feet with moist gangrene .Methods 1 845 samples of secretion from the patients with di-abetic feet complicating moist gangrene in the vasculitis department of our hospital from January 2010 to December 2014 were selected for isolating the multi-drug resistant bacteria .Their distribution and the multi-drug resistant char-acteristics of Gram-negative bacteria ,Gram-positive bacteria ,anaerobion and fungi were analyzed .Results Among i-solated 465 strains of multi-drug resistant bacteria ,274 strains (58 .92% ) were Gram-negative bacteria and 191 strains (41 .08% ) were Gram-positive cocci .Most of multi-drug resistant Gram-negative bacteria were Escherichia coli (37 .60% ) and most of multi-resistant Gram-positive bacteria were coagulase-negative staphylococci (51 .30% );among multi-drug resistant Gram-negative bacteria ,ESBLs-producing Escherichia coli and Klebsiella pneumoniae , Acinetobacter Baumann hemolysis ,Pseudomonas aeruginosa showed highly drug resistance ,the drug resistance rate reached more than 50 .00% ;among multi-drug resistant Gram-positive cocci ,coagulase-negative staphylococci and Staphylococcus aureus were methicillin-resistant strains ,these strains showed the high drug resistance ,the drug re-sistance rate reached up to more than 85 .00% .Conclusion Among multi-drug resistant bacteria in diabetic feet with moist gangrene ,Escherichia coli ,Klebsiella pneumoniae ,coagulase-negative staphylococci and Staphylococcus aureus display high drug resistance rate ,clinic should select antibacterial drugs by combining with the drug resistance identi-fication and analysis .