Distribution, antibiotic resistance and metabolic factors of pathogenic bacteria in diabetic foot infection: an analysis based on 286 patients in Chongqing

Ruomei YANG; Qing ZHOU; Yingsha LI; Hongbo HE; Zhigang ZHAO; Hexuan ZHANG; Liqin YANG; Zhiming ZHU; Zhencheng YAN

doi:10.16016/j.1000-5404.202002199

您当前的位置：

首页 >

文章列表页 >

Distribution, antibiotic resistance and metabolic factors of pathogenic bacteria in diabetic foot infection: an analysis based on 286 patients in Chongqing

Clinical Medicine | 更新时间：2026-01-09

- Distribution, antibiotic resistance and metabolic factors of pathogenic bacteria in diabetic foot infection: an analysis based on 286 patients in Chongqing
- Journal of Third Military Medical University Vol. 42, Issue 13, Pages: 1331-1337(2020)
- 作者机构：
  
  400042 重庆, 陆军军医大学(第三军医大学)大坪医院高血压内分泌科, 全军高血压代谢病中心, 重庆市高血压研究所
- 作者简介：
- 基金信息：
  
  the General Program of Natural Science Foundation of Chongqing(CSTC2019jcyj-msxmX0152)
- DOI：10.16016/j.1000-5404.202002199
  CLC： R195.4;R372;R587.2
- Received：26 February 2020，
  
  Revised：2020-04-04，
  
  Published：15 July 2020
- 稿件说明：
移动端阅览
Ruomei YANG, Qing ZHOU, Yingsha LI, et al. Distribution, antibiotic resistance and metabolic factors of pathogenic bacteria in diabetic foot infection: an analysis based on 286 patients in Chongqing[J]. Journal of Third Military Medical University, 2020, 42(13): 1331-1337.
DOI：

Ruomei YANG, Qing ZHOU, Yingsha LI, et al. Distribution, antibiotic resistance and metabolic factors of pathogenic bacteria in diabetic foot infection: an analysis based on 286 patients in Chongqing[J]. Journal of Third Military Medical University, 2020, 42(13): 1331-1337. DOI： 10.16016/j.1000-5404.202002199.

摘要

目的

研究糖尿病足感染(diabetic foot infection

DFI)患者的病原菌特征和药敏试验结果

分析影响足部疾病进展的代谢因素。

方法

选取从2013年1月至2019年7月在我院高血压内分泌科住院的286例DFI患者为研究对象

无菌采集足部溃疡深部组织进行病原菌培养和鉴定并进行药敏试验

分析DFI患者的病原菌感染类型和药敏试验特征; 依据Wagner分级标准

将研究对象分为轻型DFI组和重型DFI组

比较两组之间病原菌特征、耐药性、生化指标情况; 采用

Spearman

相关分析研究影响足部病变的指标; 采用二分类Logistic回归评估足部病情加重的危险因素。

结果

268例(93.71%)患者共培养出420株病原菌

主要包括金黄色葡萄球菌(21.90%)、铜绿假单胞菌(8.81%)和粪肠球菌(6.67%)等。药敏试验结果表明：14.13%金黄色葡萄球菌为耐甲氧西林金黄色葡萄球菌(methicillin-resistant

Staphylococcus aureus

MRSA); 粪肠球菌均为多重耐药(multi-drug resistant

MDR)菌; 在肺炎克雷伯菌及大肠埃希菌中

分别有10株(43.48%)和10株(50.00%)为产ESBLs菌株。与轻型DFI患者比较

重型DFI患者由革兰阴性菌混合感染和MDR革兰阴性菌感染的比例升高(

0.05)

且中性粒细胞百分比(neutrophils percentage

NEUT%)、降钙素原(procalcitonin

PCT)和C反应蛋白(C-reactive protein

CRP)水平升高(

0.05)

但体质量指数(body mass index

BMI)、白蛋白(albumin

ALB)、总胆固醇(total cholesterol

TC)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol

HDL-C)、血红蛋白(hemoglobin

Hb)和趾肱指数(toe brachial index

TBI)水平降低(

0.05)。

Spearman

相关分析显示：足部病变轻重与PCT、白细胞(white blood cell count

WBC)、NEUT%、CRP和TC呈正相关(

0.05)

与TBI、ALB、Hb、甘油三酯(triglyceride

TG)和HDL-C呈负相关(

0.05)。Logistic回归分析显示：TC(

=2.136

95% CI: 1.352~3.372

=0.001)是糖尿病足部病情加重的危险因素。

结论

重庆地区重型DFI患者足部溃疡感染的病原菌主要以混合革兰阴性菌和MDR革兰阴性菌为主; PCT、WBC、NEUT%、CRP、TBI、ALB、Hb、TC、TG和HDL-C是反应足部病情的重要因素。

Abstract

Objective

To investigate the characteristics and antibiotic resistance of pathogens in patients with diabetic foot infection (DFI) and to analyze the metabolic factors for the progression of foot disease.

Methods

A total of 286 DFI patients admitted in our department from January

2013 to July

2019 were recruited in this study. After tissue specimens were harvested from deep part of infected skin lesions under aseptic condition

the obtained microorganisms were identified and antimicrobial susceptibility tests were carried out. According to Wagner classification standard

the DFI patients were divided into mild and severe DFI groups. Characteristics and drug resistance of pathogenic bacteria and clinical biochemical indexes were analyzed and compared between the 2 groups. Spearman analysis was used to evaluate the correlation between clinical variables and disease progression. Logistic regression analysis was employed to identify the risk factors for exacerbation.

Results

There were 420 strains of microorganisms isolated from the 268 patients (268/286

93.71%)

including

Staphylococcus aureus

(21.90%)

Pseudomonas aeruginosa

(8.81%)

and

Enterococcus faecalis

(6.67%). About 14.13% of

Staphylococcus aureus

were methicillin-resistant

Staphylococcus aureus

(MRSA). All the

Enterococcus faecalis

strains were multidrug resistant (MDR) strains. As for

Klebsiella pneumoniae

and

Escherichia coli

nearly 10 (43.48%) and 10 (50.00%) strains were extended spectrum β-lactamases (ESBLs)-producing bacteria

respectively. The severe DFI group had significantly higher ratios of polymicrobial Gram-negative

bacteria and MDR Gram-negative bacteria infections

and increased levels of neutrophils percentage (NEUT%)

procalcitonin (PCT)

and C-reactive protein (CRP)(all

0.05)

but had obviously lower body mass index (BMI)

decreased albumin (ALB)

total cholesterol (TC)

high-density lipoprotein cholesterol (HDL-C) and hemoglobin (Hb)

and reduced toe brachial index (TBI) (all

0.05) when compared with the mild DFI group. Spearman analysis showed that the DFI severity was positively correlated with PCT

white blood cell count (WBC)

NEUT%

CRP and TC (

0.05)

while negatively correlated with TBI

ALB

triglyceride (TG)

HDL-C and Hb (

0.05). Logistic regression analysis revealed that high TC level was associated with the exacerbation of foot lesion (

=2.136

95%

: 1.352~3.372

=0.001).

Conclusion

Polymicrobial Gram-negative bacteria and MDR Gram-negative bacteria are prevalent in severe DFI patients in Chongqing. PCT

WBC

NEUT%

CRP

TBI

ALB

TG and HDL-C are important factors associated with foot lesion.

关键词

Keywords

references

NIKOLOUDI M, ELEFTHERIADOU I, TENTOLOURIS A, et al . Diabetic foot infections: update on management[J ] . Curr Infect Dis Rep, 2018, 20(10): 40. DOI:10.1007/s11908-018-0645-6.

UÇKAY I, ARAGÓN-SÁNCHEZ J, LEW D, et al . Diabetic foot infections: what have we learned in the last 30 years?[J ] . Int J Infect Dis, 2015, 40: 81-91. DOI:10.1016/j.ijid.2015 .09.023.

WU M X, PAN H, LENG W L, et al . Distribution of microbes and drug susceptibility in patients with diabetic foot infections in southwest China[J ] . J Diabetes Res, 2018, 2018: 9817308. DOI:10.1155/2018/9817308.

HEDE K. Antibiotic resistance: an infectious arms race[J]. Nature, 2014, 509(7498): S2-S3. DOI:10.1038/509S2a.

HARTEMANN-HEURTIER A, ROBERT J, JACQUEMINET S, et al . Diabetic foot ulcer and multidrug-resistant organisms: risk factors and impact[J ] . Diabet Med, 2004, 21(7): 710-715. DOI:10.1111/j.1464-5491.2004.01237.x.

[World Health Organization, International Diabetes Federation. Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia: report of a WHO/IDF consultation.. https://apps.who.int/iris/handle/10665/43588 https://apps.who.int/iris/handle/10665/43588 .

[International Working Group on the Diabetic Foot. IWGDF guidelines on the prevention and management of diabetic foot disease.. https://www.iwgdfguidelines.org https://www.iwgdfguidelines.org .

WAGNER F W JR. The dysvascular foot: a system for diagnosis and treatment[J]. Foot Ankle, 1981, 2(2): 64-122. DOI: 10.1177/107110078100200202.

ALTAY F A, KUZI S, ALTAY M, et al . Predicting diabetic foot ulcer infection using the neutrophil-to-lymphocyte ratio: a prospective study[J ] . J Wound Care, 2019, 28(9): 601-607. DOI:10.12968/jowc.2019.28.9.601.

FRIERI M, KUMAR K, BOUTIN A. Antibiotic resistance[J]. J Infect Public Heal, 2017, 10(4): 369-378. DOI:10.1016/j.jiph.2016.08.007.

MELONI M, IZZO V, GIURATO L, et al . Procalcitonin is a prognostic marker of hospital outcomes in patients with critical limb ischemia and diabetic foot infection[J ] . J Diabetes Res, 2019, 2019: 4312737. DOI:10.1155/2019/4312737.

[BABAEI M R, MALEK M, ROSTAMI F T, et al . Non-invasive vascular assessment in people with type 2 diabetes: Diagnostic performance of Plethysmographic-and-Doppler derived ankle brachial index, toe brachial index, and pulse volume wave analysis for detection of peripheral arterial disease[J ] . Prim Care Diabetes, 2019: S1751-S9918(19)30208-6. DOI: 10.1016/j.pcd.2019.09.005 http://dx.doi.org/10.1016/j.pcd.2019.09.005 ..

TASCI I, SAFER U, NAHARCI M I. Multiple antihyperglycemic drug use is associated with undernutrition among older adults with type 2 diabetes mellitus: a cross-sectional study[J]. Diabetes Ther, 2019, 10(3): 1005-1018. DOI:10.1007/s13300-019-0602-x.

KHAN M S, CHANDANPREET S, KEWAL K, et al . Malnutrition, anthropometric, and biochemical abnormalities in patients with diabetic nephropathy[J ] . J Ren Nutr, 2009, 19(4): 275-282. DOI:10.1053/j.jrn.2009.01.026.

SAINTRAIN M V L, SANDRIN R L E S P, BEZERRA C B, et al . Nutritional assessment of older adults with diabetes mellitus[J ] . Diabetes Res Clin Pract, 2019, 155: 107819. DOI:10.1016/j.diabres.2019.107819.

YE J N, MANI R. A systematic review and meta-analysis of nutritional supplementation in chronic lower extremity wounds[J]. Int J Low Extrem Wounds, 2016, 15(4): 296-302. DOI:10.1177/1534734616674624.

CAO Y C, YAN L Q, GUO N, et al . Non-high-density lipoprotein cholesterol and risk of cardiovascular disease in the general population and patients with type 2 diabetes: a systematic review and meta-analysis[J ] . Diabetes Res Clin Pract, 2019, 147: 1-8. DOI:10.1016/j.diabres.2018.11.002.

LI X, XIAO T, WANG Y Z, et al . Incidence, risk factors for amputation among patients with diabetic foot ulcer in a Chinese tertiary hospital[J ] . Diabetes Res Clin Pract, 2011, 93(1): 26-30. DOI:10.1016/j.diabres.2011.03.014.

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Distribution and antimicrobial resistance in 277 cases with diabetic foot infection

Characteristics of bacterial infection and its relationship with vascular lesions in lower limbs of patient with diabetic foot

Clinical characteristics and pathogenic drug resistance analysis of deep sternal wound infection after cardiac surgery

Related Author

王渊

徐静

王敏

张春林

童强

刘佳为

闫振成

祝之明

Related Institution

No data

⁰