老年糖尿病足患者发生MDR感染的病原菌、耐药性及其危险因素探讨

摘要/Abstract

摘要： 目的：探讨中老年糖尿病足患者发生多药耐药菌（MDR）感染的病原菌、耐药性及其危险因素。方法：选取我院2015年6月至2017年6月收治的中老年糖尿病足患者221例，对患者感染处进行病原菌检测及药敏试验。观察患者MDR感染发生情况、病原菌构成比、主要病原菌耐药性以及影响MDR感染的危险因素，并通过单因素统计分析及多因素Logistic回归分析探讨发生感染的原因及独立危险因素。结果：221例患者中，有45例发生MDR感染，检出率为20.36%。45例发生MDR感染患者中，共检出病原菌68株，其中革兰阳性菌29株（42.65%），以金黄色葡萄球菌为主，革兰阴性菌39株（57.35%），以铜绿假单胞菌为主。金黄色葡萄球菌对氨苄西林/舒巴坦、苯唑西林、头孢唑林耐药性最高，均为100%，铜绿假单胞菌对氨苄西林/舒巴坦、头孢曲松、左氧氟沙星耐药性较高，大肠埃希菌对哌拉西林/他唑巴坦、头孢噻吩、头孢哌酮、左氧氟沙星耐药性最高，均为100%。糖尿病病程≥15年、合并缺血性溃疡、骨髓炎、抗菌药物使用种类≥2种，使用时间≥30 d、溃疡大小≥4 cm2、Wagneer分级为3~5级均为影响中老年糖尿病足患者MDR感染的危险因素（P<0.05）。经多因素Logistic回归分析，合并骨髓炎、抗菌药物使用时间≥30 d、Wagneer分级为3~5级以及合并缺血性溃疡为影响患者MDR感染的独立危险因素（P<0.05）。结论：中老年糖尿病足患者MDR感染的发生率较高，主要为革兰阴性菌，对多种药物普遍耐药，合并骨髓炎、抗菌药物使用时间≥30 d、Wagneer分级为3~5级以及合并缺血性溃疡为影响患者MDR感染的独立危险因素。

Abstract: Objective：To investigate the pathogenic bacteria， drug resistance and risk factors of MDR infection in middleaged and elderly diabetic foot patients. Methods：221 middle-aged and elderly patients with diabetic foot admitted to our hospital from June 2015 to June 2017 were selected. Pathogenic bacteria detection and drug susceptibility tests were carried out for the patients. The incidence of MDR infection， the proportion of pathogenic bacteria， drug resistance of main pathogenic bacteria and the risk factors affecting MDR infection were observed. The causes and independent risk factors of MDR infection were analyzed by univariate statistical analysis and multivariate Logistic regression analysis. Results： Among the 221 patients， 45 cases had MDR infection， and the detection rate was 20.36%.A total of 68 strains of pathogenic bacteria were detected in 45 patients with MDR infection， among which 29 strains (42.65%) were Gram-positive bacteria， mainly Staphylococcus aureus， 39 strains (57.35%) were Gram-negative bacteria， and mainly Pseudomonas aeruginosa. Staphylococcus aureus had the highest resistance to ampicillin/sulbactam， oxacillin and cefazolin (100%). Pseudomonas aeruginosa had the higher resistance to ampicillin/sulbactam， ceftriaxone and levofloxacin. Escherichia coli had the highest resistance to piperacillin/tazobactam， cefalotin， cefoperazone and levofloxacin (100%). The course of diabetes ≥15 years， ischemic ulcer， osteomyelitis， types of antibiotics used ≥2， antibiotics use time ≥30 d， ulcer size ≥4 cm2 and Wagneer grade 3-5 were all risk factors for MDR infection in middle-aged and elderly diabetic foot patients (P<0.05). Multivariate Logistic regression analysis showed that the independent risk factors of MDR infection were osteomyelitis， antibiotics use time ≥30 d， Wagneer grade 3-5 and ischemic ulcer (P<0.05). Conclusion：The incidence of MDR infection in middle-aged and elderly patients with diabetic foot is high， mainly gram-negative bacteria， and is generally resistant to many drugs The independent risk factors of MDR infection in middle-aged and elderly patients are osteomyelitis， antibiotics use time ≥30 d， Wagneer grade 3-5 and ischemic ulcer.

毛喆. 老年糖尿病足患者发生MDR感染的病原菌、耐药性及其危险因素探讨[J]. .

MAO Zhe. Pathogenic Bacteria， Drug Resistance and Risk Factors of MDR Infection in Middle-aged and Elderly Diabetic Foot Patients[J]. .

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