青岛地区糖尿病足患者菌群特征分析及初、复发患者临床特征差异性分析

Analysis of Flora Characteristics of Patients with Diabetes Foot in Qingdao Area and Analysis of Differences in Clinical Characteristics of Patients with Initial and Recurrent Disease

摘要: 目的：分析青岛市市南区中医外科初、复发糖尿病足患者的临床特征、创面细菌分布、药敏性及复发因素。方法：采用回顾性研究，评估2017年5月至2023年5月482例糖尿病足患者的病原菌分布和临床资料，分为初发组和复发组，比较临床特征差异，并进行logistic回归分析。结果：(1) 共分离出587株细菌，革兰氏阳性菌占46.17%，革兰氏阴性菌占53.83%。随着Wagner级别升高，革兰氏阳性菌比例下降，阴性菌比例上升。主要菌种包括金黄色葡萄球菌、粪肠球菌、铜绿假单胞菌等。(2) 细菌药敏性各异，金黄色葡萄球菌对青霉素高度耐药，对苯唑西林、庆大霉素敏感；表皮葡萄球菌对青霉素、红霉素完全耐药；粪肠球菌对青霉素敏感，对红霉素耐药；大肠埃希菌对氨苄西林耐药，对头孢哌酮钠舒巴坦钠等敏感；阴沟肠杆菌和铜绿假单胞菌对多种抗生素耐药情况各异。(3) 轻度与重度感染患者的年龄、糖尿病病程无显著差异，但性别、吸烟史及并发症存在显著差异，男性、有吸烟史及并发症者更易复发。(4) 纤维蛋白原、前白蛋白、血红蛋白、D-二聚体、T3和T4是预测复发的显著生化指标，其中纤维蛋白原和D-二聚体与复发风险正相关，前白蛋白、血红蛋白、T3和T4负相关。结论：随着糖尿病足严重程度增加，革兰氏阴性菌比例上升，细菌药敏性各异，需针对性用药。男性、有吸烟史及并发症者更易复发。纤维蛋白原、前白蛋白等指标能预测复发风险。

Abstract: Objective: The clinical characteristics, wound bacterial distribution, drug susceptibility and recurrence factors of patients with recurrent diabetic foot in the Department of Traditional Chinese Medicine Surgery in South Qingdao District were analyzed. Methods: A retrospective study was conducted to evaluate the pathogenic bacteria distribution and clinical data of 482 patients with diabetes foot from May 2017 to May 2023. They were divided into the initial group and the recurrence group. The differences in clinical characteristics were compared and logistic regression analysis was performed. Result: (1) A total of 587 bacterial strains were isolated, with Gram positive bacteria accounting for 46.17% and Gram negative bacteria accounting for 53.83%. As Wagner level increases, the proportion of Gram positive bacteria decreases and the proportion of Gram negative bacteria increases. The main bacterial strains include Staphylococcus aureus, Enterococcus faecalis, Pseudomonas aeruginosa, etc. (2) Bacterial drug sensitivity varies, with Staphylococcus aureus highly resistant to penicillin and sensitive to ampicillin and gentamicin; Staphylococcus epidermidis is completely resistant to penicillin and erythromycin; Enterococcus faecalis is sensitive to penicillin and resistant to erythromycin; Escherichia coli is resistant to ampicillin and sensitive to cefoperazone sodium and sulbactam sodium; The resistance of Escherichia coli and Pseudomonas aeruginosa to multiple antibiotics varies. (3) There was no significant difference in age and duration of diabetes between mild and severe infection patients, but there were significant differences in gender, smoking history and complications. Male patients, those with smoking history and complications were more likely to relapse. (4) Fibrinogen, prealbumin, hemoglobin, D-dimer, T3, and T4 are significant biochemical indicators for predicting recurrence, with fibrinogen and D-dimer positively correlated with recurrence risk and prealbumin, hemoglobin, T3, and T4 negatively correlated. Conclusion: As the severity of diabetes foot increases, the proportion of Gram negative bacteria increases. Bacterial drug sensitivity varies and requires targeted medication. Men with a history of smoking and complications are more prone to recurrence. Fibrinogen, prealbumin and other indicators can predict the risk of recurrence.