糖尿病足感染患者创面病原菌分布及耐药性分析

Analysis of Distribution and Drug Resistance of Pathogens in Wounds of Patients with Diabetic Foot Infection

摘要: 目的：本研究旨在分析糖尿病足溃疡患者创面感染的病原菌种类及其对药物的敏感性，以便为本地区内类似患者的合理抗感染治疗提供参考。方法：选取2021年3月至2024年3月我院内分泌科收治的309例确诊为糖尿病足溃疡且创面分泌物培养为阳性的患者，回顾性分析病原菌的分布，以及主要病原微生物对临床常用抗菌药物的敏感性及耐药性情况。结果：纳入的309例患者中，共分离出485株菌株，其中革兰氏阳性菌301株(62.1%)，革兰氏阴性菌146株(30.1%)，真菌38株(7.8%)。在G+菌株中，金黄色葡萄球菌占32.6% (98/301)、纹带棒状杆菌占13.6% (41/301)、粪肠球菌占6.6% (20/301)、咽峡炎链球菌占6.6% (20/301)、溶血葡萄球菌占6.3% (19/301)；在G−菌株中，铜绿假单胞菌占17.8% (26/146)、大肠埃希氏菌占11.6% (17/146)、粘质沙雷氏菌占8.9% (13/146)、普通变形菌占8.2% (12/146)、阴沟肠杆菌占8.2% (12/146)。药敏实验结果表明：主要革兰阳性菌对万古霉素、利奈唑胺、替考拉宁、替加环素敏感率高，而对红霉素、阿奇霉素、克林霉素、克拉霉素则表现出较高的耐药率；主要革兰阴性菌对亚胺培南、美罗培南、哌拉西林他唑巴坦、氨曲南、阿米卡星、妥布霉素、庆大霉素、异帕米星敏感率较高，而对头孢呋辛酯、氨苄西林耐药率较高。结论：糖尿病足合并感染患者的病原菌分布较为复杂，以革兰氏阳性菌和革兰氏阴性菌为主，少数为真菌，部分抗菌药物存在敏感度较低问题，需结合病原微生物培养和药敏实验结果，根据患者具体情况选择敏感抗生素治疗，减少耐药菌株的产生，在创面的综合治疗中发挥重要作用。

Abstract: Objective: To analyze the distribution of pathogens and drug sensitivity test results in the wounds of patients with diabetic foot ulcers, and provide a basis for standardized anti-infection treatment for such patients in this region. Methods: A total of 309 patients diagnosed with diabetic foot ulcers and with positive wound secretion culture who were admitted to the Department of Endocrinology of our hospital from March 2021 to March 2024 were selected to retrospectively analyze the distribution of pathogens, as well as the sensitivity and resistance of the main pathogenic microorganisms to commonly used clinical antimicrobial drugs. Results: A total of 485 strains were isolated from the 309 patients, including 301 strains (62.1%) of Gram-positive bacteria, 146 strains (30.1%) of Gram-negative bacteria, and 38 strains (7.8%) of fungi. Among the G+ strains, Staphylococcus aureus accounted for 32.6% (98/301), Corynebacterium striatum accounted for 13.6% (41/301), Enterococcus faecalis accounted for 6.6% (20/301), Streptococcus anginosus accounted for 6.6% (20/301), and Staphylococcus haemolyticus accounted for 6.3% (19/301); among the G− strains, Pseudomonas aeruginosa accounted for 17.8% (26/146), Escherichia coli accounted for 11.6% (17/146), Serratia marcescens accounted for 8.9% (13/146), Proteus vulgaris accounted for 8.2% (12/146), and Enterobacter cloacae accounted for 8.2% (12/146). The drug sensitivity results of the main pathogens to commonly used clinical antibiotics showed that the main Gram-positive bacteria were highly sensitive to vancomycin, linezolid, teicoplanin, and tigecycline, and had high resistance rates to erythromycin, azithromycin, clindamycin, and clarithromycin; the main Gram-negative bacteria were highly sensitive to imipenem, meropenem, piperacillin-tazobactam, aztreonam, amikacin, tobramycin, gentamicin, and isopamicin, and had high resistance rates to cefuroxime axetil and ampicillin. Conclusion: The distribution of pathogens in patients with diabetic foot infection is relatively complex, mainly Gram-positive bacteria and Gram-negative bacteria, with a few being fungi. Some antimicrobial drugs have low sensitivity. It is necessary to combine the results of pathogen culture and drug sensitivity tests, select sensitive antibiotics for treatment according to the specific circumstances of the patient, reduce the production of drug-resistant strains, and play an important role in the comprehensive treatment of wounds.