糖尿病足患者感染耐甲氧西林葡萄球菌的危险因素分析

目的 观察糖尿病足(DF)患者感染病原菌的分布特点,并探讨DF患者感染耐甲氧西林金黄色葡萄球菌( MRSA)、耐甲氧西林表皮葡萄球菌(MRSE)的危险因素.方法 收集2008年1月至2010年6月天津医科大学代谢病医院388例DF溃疡住院患者的临床资料,分析感染病原菌的分布特点,将感染金黄色葡萄球菌的患者分为MRSA组和甲氧西林敏感金黄色葡萄球菌(MSSA)组,感染表皮葡萄球菌的患者分为MRSE组和甲氧西林敏感表皮葡萄球菌(MSSE)组,分别对比分析前两组和后两组患者的临床特点,采用非条件Logistic回归分析DF感染MRSA、MRSE的危险因素.结果 388例DF患者共分离出362株病原体,以G+菌为主,共207株(57.2％),G-杆菌142株(39.2％),真菌13例(3.6％).最常分离的前3种病原菌为金黄色葡萄球菌(27.1％,98/362)、表皮葡萄球菌(18.8％,68/362)、绿脓杆菌(15.5％,56/362).单因素分析中,MRSA组与MSSA组患者比较,在入院前6个月内应用抗生素、溃疡程度(面积、深浅)、骨髓炎、高血压、贫血、低蛋白血症、红细胞沉降率方面差异有统计学意义(P＜0.05);MRSE与MSSE组患者比较,在溃疡是否复发,合并骨髓炎、低蛋白血症、糖化血红蛋白、血清总蛋白方面差异有统计学意义(P＜0.05).非条件Logistic回归分析显示,入院前6个月内应用抗生素、溃疡病程、骨髓炎、高血压、低蛋白血症是DF患者感染MRSA的危险因素.糖化血红蛋白是DF患者感染MRSE的危险因素.结论 DF患者感染的病原菌以G+球菌为主;DF患者感染MRSA的相关危险因素为溃疡病程长、合并骨髓炎、高血压、低蛋白血症、入院前6个月内应用抗生素:糖化血红蛋白是DF感染MRSE的独立危险因素.

Risk factors for infections of methicillin-resistant Staphylococci in diabetic foot patients

Objective To examine the distribution patterns of pathogens isolated from the patients with diabetic foot ulcers and explore the risk factors for infections of methicillin-resistant S.aureus (MRSA)or methicillin-resistant S.epidermidis (MRSE).Methods A total of 388 diabetic-foot patients hospitalized at Tianjin Metabolic Diseases Hospital between January 2008 and June 2010 were recruited.The distribution profiles of pathogens isolated from diabetic foot ulcers were summarized. The patients with S. aureus infections were divided into MRSA and MSSA groups while those with S.epidermidis infections into MRSE and MSSE groups. The clinical features of these patients were compared between all groups. Logistic regression was employed to identify the risk factors for the MRSA/MRSE infections.Results A total of 362 pathogens were isolated from them.And the Gram-positive bacteria were the most predominant (57.2％,207/362),followed by Gram-negative bacilli (39.2％,142/362 ) and true fungi ( 3.6％,13/362 ).The three most frequently isolated pathogens were S. aureus ( 27.1％ ),S. epidermidis ( 18.8％ ) and Pseudomonas aeruginosa (15.5％). Statistically significant differences existed in antibiotic usage in 6 months prior to hospitalization,course of ulcer,ulcer size,deep ulcer,osteomyelitis,hypertension,anemia,hypoproteinemia and erythrocyte sedimentation rate between the patients infected with MRSA and MSSA (P ＜ 0.05 ). The MRSE infection was correlated with recurrent ulcer, osteomyelitis,hypoproteinemia,HbA1c and lower total serum protein (P ＜0.05).Multiple Logistic regression analysis revealed that antibiotic usage in 6 months prior to hospitalization,long course of ulcer,osteomyelitis,hypertension and hypoproteinemia were risk factors for the MRSA infection.And HbA1c was a risk factor for the MRSE infection.Conclusion In the present study,the Gram-positive cocci are the main pathogens isolated from diabetic foot ulcers. And S. aureus and S. epidermidis are the most frequently isolated pathogens.Antibiotic usage in 6 months prior to hospitalization,long course of ulcer,osteomyelitis,hypertension and hypoproteinemia are risk factors for the MRSA infection.And HbA1c is a risk factor for the MRSE infection.