糖尿病足感染的病原菌特征及耐药性分析

目的:探讨糖尿病足感染（DFI）患者不同感染级别的病原菌特征及耐药特点。方法:选取2020年5月—2021年2月天津医科大学朱宪彝纪念医院糖尿病足科住院的212例DFI患者，对感染的病原菌类型及耐药特点进行回顾性分析，并依据DFI严重程度的分级标准将患者分为中度DFI组和重度DFI组，比较两组间病原菌特征及耐药情况。结果:212例患者足分泌物标本中共分离出287株病原菌，前3位为鲍曼不动杆菌（11.50%）、肺炎克雷伯菌（11.15%）、金黄色葡萄球菌（10.80%）。革兰阳性菌以金黄色葡萄球菌为主，对万古霉素、利奈唑胺、奎奴普丁/达福普汀敏感率均为100%。革兰阴性菌中，中度DFI以鲍曼不动杆菌为主，且多为碳青霉烯类耐药菌株（CR-AB），仅对替加环素敏感；重度DFI以肺炎克雷伯菌为主，对阿米卡星、碳青霉烯类、哌拉西林/他唑巴坦均100%敏感。与中度DFI患者比较，重度DFI患者中混合感染的比例升高（44.68% vs.29.09%，P<0.05）。检出的多重耐药菌中革兰阴性菌总体耐药率（19.46%）高于革兰阳性菌总体耐药率（11.96%），以CR-AB和产超广谱β-内酰胺酶（ESBLs）大肠埃希菌为主。结论:DFI患者感染的病原菌以革兰阴性菌为主，但中、重度感染菌群分布不同。随着感染程度分级的加重糖尿病足混合感染的比例升高。检出的多重耐药菌以CR-AB和产ESBLs大肠埃希菌为主。

Analysis of pathogen distribution and antibiotic resistance of diabetic foot infection

Objective: To investigate the distribution and antibiotic resistance of pathogenic bacteria from diabetic foot infection（DFI） of different levels of infection. Methods: A total of 212 inpatients with DFI in Chu Hsien-I Memorial Hospitalof Tianjin Medical University from May 2020 to February 2021 were selected as the research subjects. The types and drug resistance characteristics of the pathogens were retrospectively analyzed.According to the grading standard of DFI severity，the subjects were divided into moderate DFI group and severe DFI group，and the characteristics of pathogen and drug resistance were compared between the two groups. Results:A total of 287 pathogenic bacteria were isolated from the foot wounds of 212 patients.The top three were Acinetobacter baumannii（11.50%），Klebsiella pneumoniae（11.15%），and Staphylococcus aureus（10.80%）.The main gram-positive bacteria from DFI wounds were Staphylococcus aureus，and the susceptibility rate to vancomycin，linezolid，quinupridine/dalfopristin was 100%.Among the Gram-negative bacteria，Acinetobacter baumannii was the main bacteria with moderate DFI，and most of them were carbapenem resistant（CR-AB），only sensitive to tigecycline.Severe DFI was mainly caused by Klebsiella pneumoniae，which was 100% sensitive to amikacin，carbapenems and piperacillin/tazobactam. Compared with moderate DFI patients，the proportion of mixed infection in severe DFI patients was increased（44.68% vs.29.09%，P<0.05）.The overall resistance rate of Gram-negative bacteria（19.46%） was higher than that of Gram-positive bacteria（11.96%）.The main multidrug-resistant organisms were CR-AB and extended-spectrum beta-lactamase-producing（ESBLs）Escherichia coli. Conclusion: Gram-negative bacteria are the main pathogens of DFI infection，but the distribution of pathogens in moderate and severe infection is different.With the aggravation of infection，the proportion of mixed infection of diabetic foot increases.CR-AB and ESBLs producing Escherichia coli are the main multidrug-resistant bacteria.