2型糖尿病合并血流感染者临床特征和病原菌分布

目的分析2型糖尿病合并血流感染者的临床特征和病原菌分布，探讨更有效和便捷的治疗方式。 方法回顾性分析2014年4月至2018年4月于张家港市第六人民医院诊治的92例2型糖尿病合并血流感染者临床特征、病原菌分布及药敏特征，并采用Cox回归法分析影响2型糖尿病合并血流感染预后的危险因素。 结果92例2型糖尿病合并血流感染者以体重指数（BMI）< 18.5 kg/m²（47/92、51.09%）、中低热（29/92、72.82%）、发热持续时间≥ 7 d（62/92、67.39%）、病程≥ 10 d（68/92、73.91%）、皮肤感染（50/92、54.35%）和住院时间≥ 15 d（53/92、57.61%）为主，治愈率为84.78%（78/92）。血培养结果显示，革兰阳性菌感染23例（25.00%），以金黄色葡萄球菌（8/92、8.70%）和凝固酶阴性葡萄球菌（7/92、7.61%）为主；革兰阴性菌感染69例（75.00%），以大肠埃希菌（32/92、34.79%）和肺炎克雷伯菌（14/92、15.22%）为主。药敏试验结果显示，金黄色葡萄球菌敏感药物主要为万古霉素、庆大霉素和克林霉素，敏感性分别为100.00%（8/8）、75.00%（6/8）和50.00%（4/8）；凝固酶阴性葡萄球菌敏感药物主要为万古霉素和克林霉素，敏感性分别为100.00%（7/7）和57.14%（4/7）；大肠埃希菌敏感药物主要为哌拉西林/他唑巴坦和氨曲南，敏感性分别为96.88%（31/32）和90.63%（29/32）；肺炎克雷伯菌敏感药物主要为哌拉西林/他唑巴坦和头孢替坦，敏感性分别为92.86%（13/14）和85.72%（12/14）。Cox回归单因素分析结果显示，HbA1c（P < 0.001）、BMI > 23.9 kg/m²（P = 0.03）、高热（P = 0.08）、发热持续时间≥ 7 d（P = 0.09）、病程≥ 10 d（P = 0.09）及多器官功能衰竭（P < 0.001）均为影响预后的危险因素（单因素纳入标准为P < 0.1）；Cox回归多因素分析示HbA1c（P = 0.01）和多器官功能衰竭（P < 0.001）为影响2型糖尿病合并血流感染预后的独立危险因素。 结论2型糖尿病合并血流感染以血糖控制不佳、高BMI、持续中低热、病程长、皮肤感染、住院时间长为主要临床特征；多为革兰阴性菌感染，且耐药严重，临床须尽早完成血培养及药敏试验，以指导临床合理用药。

Clinical characteristics and distribution of pathogens in patients with type 2 diabetes complicated with bloodstream infection

ObjectiveTo investigate the clinical characteristics and pathogenic bacteria distribution of patients with type 2 diabetes mellitus complicated with bloodstream infection, and to provide more effective and convenient treatment. MethodsThe clinical characteristics, pathogenic bacteria distribution and drug sensitivity of 92 patients with type 2 diabetes mellitus complicated with blood flow infection treated in the Sixth People’s Hospital of Zhangjiagang City from April 2014 to April 2018 were analyzed, retrospectively; while the risk factors influencing the prognosis of type 2 diabetes complicated with blood flow infection were analyzed by Cox regression. ResultsThe 92 patients with type 2 diabetes mellitus complicated with blood flow infection were mainly with body mass index (BMI) < 18.5 kg/m² (47/92, 51.09%), moderate and low fever (29/92, 72.82%), fever duration ≥ 7 d (62/92, 67.39%), course of disease ≥ 10 d (68/92, 73.91%), skin infection (50/92, 54.35%) and length hospitalization ≥ 15 d (53/92, 57.61%). The cure rate was only 84.78% (78/92). The results of blood culture showed that 23 cases (25.00%) were with Gram-positive bacteria infection, mainly Staphylococcus aureus (8/92, 8.70%) and coagulase-negative Staphylococcus (7/92, 7.61%); 69 cases (75.00%) were with Gram-negative bacteria infection, mainly Escherichia coli (32/92, 34.79%) and Klebsiella pneumoniae (14/92, 15.22%). The results of drug susceptibility test showed that Staphylococcus aureus sensitive drugs were mainly vancomycin, gentamicin and clindamycin, with the sensitivity of 100.00% (8/8), 75.00% (6/8) and 50.00% (4/8), respectively. Coagulase-negative Staphylococci sensitive drugs were mainly vancomycin and clindamycin, with the sensitivity of 100.00% (7/7) and 57.14% (4/7), respectively. Escherichia coli sensitive drugs were mainly piperacillin/tazobactam and aztreonam, with the sensitivity were 96.88% (31/32) and 90.63% (29/32), respectively. The sensitive drug of Klebsiella pneumoniae were piperazepine/zuobatan and ceftitam, with the sensitivity were 92.86% (13/14) and 85.72% (12/14), respectively. Cox regression univariate analysis showed that HbA1c (P < 0.001), BMI > 23.9 kg/m² (P = 0.03), high fever (P = 0.08), fever duration≥ 7 d (P = 0.09), course of disease ≥ 10 days (P = 0.09) and multiple organ failure (P < 0.001) were all risk factors affecting the prognosis (univariate inclusion criteria were P < 0.1). Cox regression multivariate analysis showed that HbA1c (P = 0.01) and multiple organ failure (P < 0.001) were both independent risk factors affecting the prognosis of type 2 diabetes mellitus complicated with bloodstream infection. ConclusionsThe main clinical features of type 2 diabetes mellitus complicated with bloodstream infection were poor blood sugar control, high BMI, persistent low and moderate fever, long course of disease, skin infection and long hospitalization. Most of the patients were with Gram-negative bacterial infection and serious drug resistance. Blood culture and drug sensitivity should be completed as soon as possible in order to guide rational drug use in clinic.