糖尿病合并不同临床表型肺部感染者的细菌谱分析

目的探讨糖尿病合并不同临床表现肺部感染者的细菌分布情况，有针对性地制定抗感染对策。 方法根据208例糖尿病合并肺部感染者的不同临床表现分为呼吸道症状组（RS）、全身症状组（SS）及综合症状组（CS）共3组，取其痰分泌物进行病原学培养，培养菌株232株，统计学分析采用SPSS软件。 结果CS组混合感染（19.13%）较RS组（4.00%）和SS组患者（11.39%）显著上升（χ²= 5.41，P=0.01）；RS组患者革兰阳性球菌（G⁺C）感染仅占20%，SS组患者G⁺C感染占69.6%，CS组患者G⁺C感染为33.9%（χ²= 9.90，P=0.001）；RS组患者革兰阴性杆菌（G^－B）感染占76%，SS组患者G^－B感染仅占25.3%，CS组患者G^－B感染为59.3%（χ²= 14.87，P=0.001）；RS组患者葡萄球菌对莫西沙星、阿奇霉素、克林霉素、庆大霉素、左氧氟沙星、环丙沙星、四环素、青霉素、利福平、头孢呋辛和头孢唑肟耐药率显著低于SS组和CS组（P均< 0.05）。SS组患者链球菌对莫西沙星、阿奇霉素、克林霉素、四环素、头孢呋辛及头孢唑肟耐药率显著低于CS组（P均< 0.05）；SS组患者ECO对莫西沙星、庆大霉素及头孢唑肟耐药率显著低于CS组（P均< 0.05）；RS组患者肺炎克雷伯菌对亚胺培南、头孢哌酮舒巴坦、哌拉西林他唑巴坦、头孢吡肟、头孢噻汚、头孢他啶、头孢唑肟、庆大霉素、环丙沙星、左氧氟沙星、氨曲南和氨苄西林耐药率显著低于SS组和CS组患者（P均< 0.05）；RS组患者中铜绿假单胞杆菌和鲍曼/溶血不动杆菌对头孢哌酮舒巴坦、哌拉西林他唑巴坦、头孢吡肟、头孢噻汚、头孢他啶、头孢唑肟、庆大霉素、环丙沙星、左氧氟沙星、氨曲南及氨苄西林耐药率显著低于SS组和CS组患者（P均< 0.05）。 结论糖尿病合并不同临床表型肺部感染患者的细菌谱分布存在差异；针对以上感染特点有助于指导临床进行抗感染治疗。

Bacterial analysis of pulmonary infection in patients with diabetes mellitus complicated with different clinical phenotypes

ObjectiveTo investigate the pathogenic conditions of pulmonary infection in patients with diabetes. MethodsTotal of 208 patients with diabetes complicated with pulmonary infection of different clinical manifestations were divided into three groups: respiratory symptoms group (RS group), systemic symptom group (SS group) and comprehensive syndrome group (CS group), and the pathogen of their sputum were cultured for 232 strains, and the statistical analysis was carried out by SPSS 16.0 software. ResultsMixed infection (19.13%) in CS group was significantly higher than those of the RS group (4.00%) and the group SS (11.39%). In patients of the RS group, the infection rate of Gram positivecocci(G⁺C) was 20%, which were 69.6% in the SS group and 33.9% in the CS group, with significant difference (χ²= 9.90,P= 0.001). G^-B infection rate of patients of the RS group was 76%, which were 25.3% in the SS group and 59.3% in the CS group, with significant difference (χ² = 14.87,P= 0.001). The resistance rates ofStaphylococcusto moxifloxacin, azithromycin, clindamycin, gentamicin, erythromycin, levofloxacin, ciprofloxacin, tetracycline, penicillin, rifampicin, cefuroxime and ceftizoxime of the RS group were significantly lower than those of SS group and CS group (allP< 0.05). The resistance rates ofStreptococcusto azithromycin, moxifloxacin, clindamycin, erythromycin, tetracycline, cefuroxime and ceftizoxime in the SS group were significantly lower than those of the CS group (allP< 0.05). The resistance rates ofEnterococcusto moxifloxacin, gentamicin and ceftizoxime in patients of the SS group were significantly lower than those of in the CS group (allP< 0.05). In patients of the RS group, the resistance rates ofKlebsiella pneumoniato imipenem, cefoperazone, cefoperazone sulbatam, piperacillin tazobactam, cefotaxime, cefotaxime, ceftazidime, ceftizoxime, gentamicin, ciprofloxacin, levofloxacin, aztreonam and ampicillin were significantly lower than those of the SS group and CS group (allP< 0.05). In patients of the RS group, the resistance rates ofPseudomonas aeruginosaandAcinetobacterto cefoperazone sulbatam, piperacillin tazobactam, cefotaxime, cefotaxime, ceftazidime, ceftizoxime, gentamicin, ciprofloxacin, levofloxacin, aztreonam and ampicillin were significantly lower than those of SS group and CS group (allP< 0.05). ConclusionsThe bacterial spectrum distribution of patients with diabetes combined with pulmonary infection of different clinical phenotypes were different. In view of the above infection characteristics, it is helpful to guide clinical antiinfection treatment.