重庆地区286例糖尿病足感染患者的病原菌特征、耐药性及代谢因素分析

杨若梅; 周晴; 李英莎; 何洪波; 赵志钢; 张和轩; 杨莉琴; 祝之明; 闫振成

doi:10.16016/j.1000-5404.202002199

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重庆地区286例糖尿病足感染患者的病原菌特征、耐药性及代谢因素分析

临床医学 | 更新时间：2026-01-09

- 重庆地区286例糖尿病足感染患者的病原菌特征、耐药性及代谢因素分析
- Distribution, antibiotic resistance and metabolic factors of pathogenic bacteria in diabetic foot infection: an analysis based on 286 patients in Chongqing
- 第三军医大学学报 2020年42卷第13期页码：1331-1337
- 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：
  
  [ 闫振成, E-mail: zhenchengyan@sina.com YAN Zhencheng, E-mail:zhenchengyan@sina.com
- 基金信息：
  
  重庆市自然科学基金面上项目(CSTC2019jcyj-msxmX0152)
- DOI：10.16016/j.1000-5404.202002199
  中图分类号： R195.4;R372;R587.2
- 收稿：2020-02-26，
  
  修回：2020-04-04，
  
  纸质出版：2020-07-15
- 稿件说明：
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杨若梅, 周晴, 李英莎, 等. 重庆地区286例糖尿病足感染患者的病原菌特征、耐药性及代谢因素分析[J]. 第三军医大学学报, 2020,42(13):1331-1337.

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.
杨若梅, 周晴, 李英莎, 等. 重庆地区286例糖尿病足感染患者的病原菌特征、耐药性及代谢因素分析[J]. 第三军医大学学报, 2020,42(13):1331-1337. DOI： 10.16016/j.1000-5404.202002199.

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

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