糖尿病足感染的细菌谱变迁与抗感染治疗

目的探讨糖尿病足感染中细菌的变化规律和主要感染细菌对抗生素敏感程度,为糖尿病足感染治疗提供最优的抗感染方案。方法收集、对比空军总医院内分泌科26a间糖尿病足感染细菌培养结果,确定糖尿病足感染细菌谱变迁情况及主要感染细菌对抗生素敏感程度。结果糖尿病足感染中革兰阳性菌感染率逐年下降,革兰阴性菌感染率逐年上升,对大部分抗生素敏感;绿脓杆菌感染明显减少,金黄色葡萄球菌中MRSA比例逐年增加,真菌感染比例有所升高。结论糖尿病足感染的细菌谱随时间变迁而改变,同阶段患足局部感染细菌的种类可能不同,或者同一种细菌在不同阶段对某一种抗生素的敏感度不同;糖尿病足感染患者中近半数为混合感染,多发生在重症患者;应多次进行创面细菌培养及药物敏感试验,根据药敏结果选择合适的抗生素。

Bacterial spectrum changes of diabetic foot infection and anti-infection treatment

Objective It is to explore the changes of bacteria spectrum in diabetic foot infection and antibiotic-sensitive status of major infectious bacteria,in order to choose the best anti-infection program.Methods 26 years’ diabetic foot infectious bacteria culture results of the Air Force General Hospital were collected and compared to determine the bacterial spectrum change of diabetic foot infection and antibiotic-sensitive status of major infectious bacteria.Results Gram-positive bacterial infection in diabetic foot infections had decreased year by year,Gram-negative bacterial infection had increased year by year,and it was sensitive to most antibiotics;Pseudomonas aeruginosa infection significantly reduced,the proportion of MRSA in Staphylococcus aureus increased year by year,the proportion of fungal infections increased.Conclusion The bacterial spectrum of diabetic foot infection changes with time,bacteria of local infectious foot in the same stage may be different types,or the same bacterium in different stages is differently sensitive to a certain antibiotics;nearly half of patients with diabetic foot suffered mixed infection,which occurred in critically ill patients;bacterial culture of wound and drug susceptibility testing should be repeated for the choose of appropriate antibiotics.