糖尿病足合并感染的菌谱分析及对策

目的通过对糖尿病足合并感染的菌谱分析，有针对性地制定抗感染对策。方法将糖尿病足合并感染分为浅溃疡组、深溃疡组及坏疽组3组，取它们的分泌物或坏死组织进行需氧、厌氧以及真菌培养。结果108例符合条件的患者统计出138个病灶（包括同一患者多个不同类型病灶），共培养菌株232株。浅溃疡组细菌培养率为95％，其中G＋（76．00％）〉G-（20．00％）〉真菌（4．00％）〉厌氧菌（0）；深溃疡组细菌培养率为100％，其中p（65．82％）〉厌氧菌（22．78％）〉G＋（8．86％）〉真菌（2．53％）；坏疽组细菌培养率达100％，其中G＋（49．05％）〉G-（27．18％）〉厌氧菌（16．50％）〉真菌（5．83％）。浅溃疡组以单一G＋菌感染为主，对大部分抗生素的耐药率在50％以下；深溃疡组以p菌的混合感染为主，混合感染率达81．08％，且混合感染中60．00％合并厌氧菌感染，大部分菌株的耐药率在50％以上；坏疽组以c＋菌的混合感染为主，混合感染率达82．35％，有40．48％的混合感染合并厌氧菌感染，且较深溃疡组更易耐药。常见抗真菌药及抗厌氧菌药对所培养出的真菌及厌氧菌均较敏感。结论糖尿病足合并感染的菌谱有其规律性，对临床早期抗感染治疗有指导意义。

Diabetic foot infection of bacterium spectrum analysis and countermeasures

Objective To analyse the bacteria spectrum of diabetic foot infection in order to develop countermeasures of anti-infection. Methods The diabetic foot infection patients were divided into three groups ：shallow ulcer group,deep ulcer group and gangrene group. Their secretions or necrotic tissue were taken aerobic,anaerobic and fungi culture. Results 108 patients were statistical meet the conditions of the 138 lesions （including a plurality of different types of lesions in the same pa- tient）, a total of 232 strains of culture. The bacterial culture rate of shallow ulcer group was 95%, G-（76.00%） 〉G-（20.00%） 〉 fungi（4.00%） 〉 anaerobic bacteria （0）; bacterial culture rate of deep ulcer group was 100%, G-（65.82%） 〉 anaerobic bacteria （22.78%） 〉G＋（8.86%） 〉 fungi（2.53%）; bacterial culture rate of gangrene group reached 100%, G＋（49.05%） 〉G- （27.18%） 〉 anaerobic bacteria （16.50%） 〉 fungi （5.83%）. The shallow ulcer group dominated by a single G＋ bacteria infection, resistance to most antibiotics rate was below 50%; deep ulcer group dominated by mixed G- bacteria infection, mixed infection rate was 81.08%, 60% mixed infection with anaerobic infection, most strains resistant rate was above 50%; gangrene group dominated by G＋ bacteria mixed infection, mixed infection rate was 82.35%, mixed infection with anaerobic bacteria infection was 40.48%, and deep ulcer group was more easily to resistance. Common antifungal drugs and anti anaerobe drug were susceptible to fungi and anaerobic bacteria developed. Conclusion Diabetic foot infection and bacteria spectrum had its regularity, the early clinical anti-infection therapy had a guiding significance.