感染耐甲氧西林金黄色葡萄球菌的糖尿病足溃疡患者的临床特点及分析

目的研究感染耐甲氧西林金黄色葡萄球菌（MRSA）的糖尿病足（DF）溃疡患者的临床特点，探讨MRSA对DF溃疡预后的影响。方法分析2005年6月-2008年5月102例DF感染（DFI）患者入院48h内及抗感染治疗后创面棉拭子和组织细菌培养结果，将其分为4组：A组16例，入院后48h内MRSA阳性；B组25例，入院后48h内甲氧西林敏感金黄色葡萄球菌（MSSA）阳性；C组27例，入院后48h内革兰氏阴性菌阳性，经抗感染治疗后MRSA阳性；D组34例，入院后48h内革兰氏阴性菌阳性，住院期间始终未分离出MRSA菌株。将A组与B组、C组与D组分别进行比较，研究感染MRSA的高危因素以及其对患者住院时间、住院费用及预后的影响。结果A、B组间WBC、RBC、白蛋白（ALB）和DF溃疡面积差异均有统计学意义（P均〈0．05），而DM病程、DF溃疡病程、住院时间、日住院费、高敏C-反应蛋白（hsC—RP）差异均无统计学意义；C、D组间DM病程差异有统计学意义（P〈0．05），而其余指标差异均无统计学意义。43株MRSA对庆大霉素／环丙沙星／红霉素／四环素耐药率均为100％。结论与MSSA阳性DFI患者比较，MRSA阳性DFI患者全身炎症反应更明显。骨髓炎、复发性溃疡、频繁住院、交叉感染及溃疡面积〉4cm^2可能是DFI患者感染MRSA的高危因素，而DF溃疡病程与其无关。DFI分离的MRSA多重耐药现象普遍存在。对DF患者及时发现MRSA菌株并清创处理，将不影响患者住院时间、住院费用及预后，避免盲目应用万古霉素等新一代抗生素，以延缓新型耐药菌的产生。

The clinical characteristics and analysis of methicillin-resistant Staphylococcus aureus infections in patients with diabetic foot ulcer

Objective To study clinical characteristics of patients with diabetic foot and infection （DFI） by methicillin-resistant staphylococcus aureus （MRSA）. Methods 102 DFI patients who were hosipitalized in Tianjin Metabolic Disease Hospital from June 2005 to May 2008 were divided into 4 groups：group A （16 cases） with positive MRSA within 48h after admission, group B （25 cases） with positive methicillin-sensitive staphylococcus aureus （MSSA） within 48h after admission, group C （27 eases） with Gram-negative bacteria within 48h after admission, but positive MRSA after anti-infective therapy, group D （34 cases） with Gram-negative bacteria within 48h after admission, and no MRSA isolation during entire hospital stay. In comparision of group A with B, and C with D, the risk factors for MRSA infection in DFI, and the effect of MRSA infections on hospitalisation costs, hospital stay days and prognosis in DFI patients were analyzed. Results There was statistical significance between group A and B in WBC,RBC,ALB and DF ulcer area （all P〈0.05）. Diabetes mellitus （DM） course differed significantly between group C and D （P〈0. 05）. The rate of antibiotic-resistance of the 43 MRSA strains to gentamicin/ciprofloxaein/amoxicillin/tetracycline were 100%. Conclusions The systemic inflammatory reaction of DF patients with MRSA infection is more severe than without MSSA infection. The risk factors of MRSA include osteomyelitis,recurrent ulcer, frequent hospitalization, cross-infection and ulcer〉 4cm^2, rather than ulcer course. If MRSA is detected timely, then debrided, the prognosis is not impacted. Accordingly,clinicist should avoid selecting latest antibiotics（e, g. vancomycin） blindly. Multi-drug resistance of MRSA isolated from DFI is a common phenomenon.