糖尿病足合并骨髓炎患者革兰阴性菌感染的临床特点及药敏分析

【摘要】目的探讨合并骨髓炎的糖尿病足溃疡（DFO）患者革兰阴性菌（G-）感染的临床特点及其耐药性。方法 收集我院91例DFO住院患者的病历资料，根据病原菌的分布特点将其中86例细菌感染的患者分为G-感染组（44例）和革兰阳性菌（G+）感染组（42例），比较2组患者的临床特点，采用非条件Logistic回归分析G-感染的危险因素，并对G-的耐药谱进行总结。结果91例DFO患者包括86例细菌感染者和5例真菌感染者。病原微生物共计112株，其中G-54株（48.2%），G+53株（47.3%），真菌5株（4.5%），G-中以铜绿假单胞菌占首位。G-感染组入院前6个月应用抗生素的比例（75.0%）高于G+感染组（52.4%），2组其他指标比较差异无统计学意义，Logistic回归分析显示，有抗生素应用史是DFO患者感染G-的独立危险因素。药敏结果显示G-对多种头孢类及喹诺酮类抗生素耐药较严重，对亚胺培南、头孢哌酮/舒巴坦、头孢他啶耐药率较低。结论DFO患者G-感染率高，耐药较普遍，对可疑糖尿病足感染患者应及时行细菌培养与药敏试验，系统合理应用抗生素。

Clinical Features and Antibiotic Sensitivity of Gram-Negative Diabetic Foot Osteomyelitis

[Abstract]ObjectiveTo investigate the clinical features and antibiotic susceptibility of osteomyelitis infected byGram-negative bacteria (G^-)in patients suffered from diabetic foot ulcers (DFU).MethodsThe clinical data of91 DFU patients accompanied with osteomyelitis (DFO) were retrospective studied. These patients hospitalized in the Tianjin Metabolic Diseases Hospital were divided into two groups, Gram-negative bacteria (G^-)group (n=44) and Gram-positive bacteria (G⁺) group (n=42), respectively. The clinical features were compared between two groups. Logistic regression analysis was used to determine the risk factors for Gram-negative bactreial infection. The Gram-negative antibiogram was summarized.ResultsA total of112pathogens were isolated from91patients. G^- bacteria were the most frequent pathogens (48.2%), following by G⁺ bacteria (47.3% ) and fungi (4.5% ).Pseudomonas aeruginosawas the majority of the G^-bacteria. Comparing the two groups, the rate of antibiotic use within the previous6months was significantly higher in G^- group (75.0%) than that of G⁺group (52.4%,P＜0.05). There were no significant differences in the other indicators between two groups. The Logistic regression analysis revealed that the history of antibiotic use was the independent risk factor of G^-bacterial infections in DFO patients. Antibiotics susceptibilities reflected G^-bacteria were more prevalent to resist to cephalosporins and quinolonem, but sensitive to imipenem, ceftazidine and cefperazone-sulbactam.ConclusionGram negative bacteria were not only the main pathogens isolated from DFO patients, but also frequently resistant to several popular antibiotics in China. The proper bacteria culture and antibiotic sensitivity test are especially emphasized to patients with DFU.