摘要
目的探讨糖尿病合并社区感染败血症临床特点及预后的多因素相关分析,以提高临床诊断治疗水平。方法对苏北医院2002年~2010年167例糖尿病合并社区感染败血症患者的临床资料进行回顾性分析。结果糖尿病合并社区感染败血症诊断例数有逐年增加趋势,女性占59.8%。革兰阳性球菌62例,占37.1%,表皮葡萄球菌、金黄色葡萄球菌最常见,主要来源于呼吸道、皮肤;革兰阴性杆菌100例,占59.8%,其中大肠埃希菌、肺炎克雷伯菌最常见,主要来源于泌尿道、胆道;真菌感染5例。细菌耐药分析大肠埃希菌产ESBL率为18.75%,肺炎克雷伯菌未见产ESBL,耐甲氧西林的葡萄球菌（MRS）占16.7%。分析糖尿病合并社区感染败血症患者单因素年龄、糖尿病病程、HbA1c、UA、Cr在不同组间的预后有显著性差异（P〈0.01或P〈0.05）,而在性别、细菌种类、感染来源和初诊血糖、BUN、CHO、TG单因素不同组间预后无显著性差异（P〉0.05）。经Logistic回归分析入选的HbA1c、UA、Cr三因素与预后显著相关（P〈0.05）。结论糖尿病合并社区感染败血症以革兰阴性杆菌略多见,但细菌种类及来源与预后无相关性。血糖控制不良、高血尿酸、高肌酐是糖尿病合并社区感染败血症患者预后的独立危险因素。
Objective To investigate the clinical characteristics and prognosis of community acquired sepsis in patients with diabetes mellitus.Methods A retrospective study was conducted on 167 diabetic patients complicated by community acquired sepsis from 2002 to 2010 in Subei People′s Hospital.Results The incidence of diabetes mellitus patients complicated with community acquired sepsis tended to increase year by year,and senile female patients took the major proportion（59.8%）.Bacteriologically,gram positive cocci was observed in 62 isolates（37.1%）,including staphylococcus epidermidis and staphylococcus aureus,meanwhile,gram negative bacilli was found in 100 patients（59.8%） especially klebsiella pneumoniae and escherichia coli,and fungal infections were found in 5 cases.Respiratory tract and skin infection were the main sources of cocci,whereas urinary tract and biliary tract infection were sources of bacilli.The positive rate of extended spectrum beta lactamase（ESBL） in escherichia coli was 18.75%,while methicillin-resistant staphylococcus（MRS） in staphylococci was 16.7%.But the detection of ESBL in klebsiella pneumonia strain was negative.There was a significant correlation between prognosis of patients in different groups and several factors including age（P0.01）,disease course（P0.01）,HbA1c（P0.01）,uric acid（UA）（P0.05） and creatinine（Cr）（P0.05）.But prognosis was not obviously correlated with gender,bacterial species,infection source,newly diagnosed glucose level,BUN、CHO and TG（P0.05）.In addition,Logistic regression analysis showed that HbA1c,UA and Cr had significant correlation with prognosis（P0.05）.Conclusion Community acquired sepsis in diabetic patients is commonly associated with gram negative bacilli.Bacterial species and infection source may not associate with the prognosis of patients.Poor glucose control, hyperuricemia and high creatinine were independent risk factors for the prognosis of diabetic patients complicated by community acquired sepsis.
出处
《实用临床医药杂志》
CAS
2010年第8期44-47,共4页
Journal of Clinical Medicine in Practice
关键词
糖尿病
败血症
社区感染
预后
Diabetes mellitus
Sepsis
community-acquired
prognosis
