糖尿病足患者发生多重耐药菌感染的危险因素研究

doi:10.12183/j.scjpm.2021.1135

摘要/Abstract

摘要： 目的探讨糖尿病足患者发生多重耐药菌（MDROs）感染的危险因素及病原菌分布情况。方法以2019年1月至2020年12月青岛市某三甲医院内分泌门诊就诊的糖尿病足患者为研究对象进行资料收集、体格检查及空腹静脉血采集,并采用灭菌棉拭子擦拭创面拭取分泌物用于病原菌感染情况及耐药性检测。采用描述流行病学分析方法进行分析,并采用单、多因素分析方法对多重耐药影响因素进行分析。结果本研究共对5 122例糖尿病足患者进行MDROs感染情况分析,年龄35~85岁,平均（61.03±11.19）岁,糖尿病病程1~29年,平均（12.32±7.16）年。多重感染者210例,多重感染率为4.10%。共分离出265株MDROs,居于前3位的MDROs分别是金黄色葡萄球菌109株（41.13%）、铜绿假单胞菌61株（23.02%）、大肠杆菌58株（21.89%）。主要的MDROs中金黄色葡萄球菌对苯唑西林、氨苄西林/舒巴坦、头孢唑林100%耐药,大肠杆菌对氨苄西林、哌拉西林/他唑巴坦、头孢他啶100%耐药,未见对万古霉素耐药菌。多因素Logistic回归分析结果显示,抗菌药物暴露史（OR=1.962）、因同一伤口住院次数>2次/年（OR=1.970）、骨髓炎（OR=4.323）、神经缺血性伤口（OR=1.269）和抗菌药物疗程≥5 d（OR=1.487、3.274、1.602）是糖尿病足患者发生MDROs感染的危险因素。结论糖尿病足患者抗菌药物暴露史、因同一伤口住院次数>2次/年、骨髓炎、神经缺血性伤口以及使用抗菌药物疗程与发生MDROs感染存在密切关系。

关键词: 糖尿病足, 多重耐药菌, 多重耐药菌感染, 危险因素

Abstract: Objective To investigate the risk factors and pathogenic bacteria distribution of patients with diabetic foot who developed multidrug-resistant organisms （MDROs） infection. Methods From January 2019 to December 2020, patients with diabetic foot in endocrinology clinic of a tertiary hospital in Qingdao were selected as the research subjects for data collection, physical examination and fasting venous blood collection, and the cotton swab was used to wipe the wound and wipe out the secretions for pathogen infection and drug resistance detection. Descriptive epidemiological analysis method was used for analysis, and univariate and multivariate analysis methods were used to analyze the influencing factors of multi-drug resistance. Results A total of 5 122 patients with diabetic foot were analyzed for MDROs infection. The patients were 35 to 85 years old, with an average of （61.03±11.19） years old, and the course of diabetes was 1 to 29 years, with an average of （12.32±7.16） years. There were 210 cases of multiple infections, and the multiple infection rate was 4.10%. A total of 265 MDROs were isolated, and the top 3 MDROs were 109 strains of Staphylococcus aureus （41.13%）, 61 strains of Pseudomonas aeruginosa （23.02%）, and 58 strains of Escherichia coli （21.89%）. Among the main MDROs, Staphylococcus aureus was 100% resistant to oxacillin, ampicillin/sulbactam, and cefazolin, and Escherichia coli was 100% resistant to ampicillin, piperacillin/tazobactam, and ceftazidime. No bacteria resistant to vancomycin. The results of multivariate Logistic regression analysis showed that the history of antimicrobial exposure （OR=1.962）, the number of hospitalizations for the same wound>2 times/year （OR=1.970）, osteomyelitis （OR=4.323）, neuro ischemic wounds （OR=1.269） and antimicrobial treatment course ≥5 d （OR=1.487, 3.274, 1.602） were risk factors for MDROs infection. Conclusion A history of antimicrobial exposure, hospitalization > 2 times/year for the same wound, osteomyelitis, neuro ischemic wounds, and the use of antimicrobial courses in diabetic foot patients are strongly associated with MDROs infection.

Key words: Diabetic foot, Multidrug-resistant organisms, MDROs infection, Risk factor

中图分类号:

R195

袁红艳, 于楠, 王媛媛. 糖尿病足患者发生多重耐药菌感染的危险因素研究[J]. 华南预防医学, 2021, 47(9): 1135-1138.

YUAN Hong-yan, YU Nan, WANG Yuan-yuan. Risk factors of multidrug-resistant organisms infection in patients with diabetic foot[J]. South China Journal of Preventive Medicine, 2021, 47(9): 1135-1138.

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