摘要
目的了解糖尿病足溃疡(DFU)创面与非糖尿病患者下肢皮肤溃疡创面中感染病原菌分布及耐药特点的差异性。方法选取2021年7月至2023年6月在安徽医科大学第一附属医院内分泌代谢病科住院治疗的DFU伴感染患者363例(DFI组),对照组选取相同时间段住院治疗的非糖尿病下肢皮肤溃疡伴感染患者100例(NDSU组)。对DFI组与NDSU组中受试者的临床及实验室资料进行回顾性分析,对比两组间溃疡创面培养出的病原菌的分布及耐药性特征。结果(1)DFI组的年龄、空腹血糖、白细胞计数、C反应蛋白均显著高于NDSU组(P<0.01),而血红蛋白、白蛋白、踝肱指数均显著低于NDSU组(P<0.01),两组间溃疡病程和性别构成的差异无统计学意义(P>0.05)。(2)DFI组混合感染比例为65.8%,显著高于NDSU组的38.0%(χ^(2)=25.284,P<0.001)。(3)DFI组中检测出病原菌数量最多的前五位依次是金黄色葡萄球菌、肠球菌、大肠埃希菌、变形菌、铜绿假单胞菌。而在NDSU组中,检出病原菌数量最多的前五位依次是金黄色葡萄球菌、铜绿假单胞菌、肺炎克雷伯菌、肠杆菌和变形菌。DFI组与NDSU组在主要病原菌种类方面存在显著差异,DFI组革兰阳性细菌的检出率明显高于NDSU组(χ^(2)=12.501,P<0.01),革兰阴性细菌的检出率显著低于NDSU组(χ^(2)=10.418,P<0.01)。(4)就药物的敏感性而言,DFI组与NDSU组间的主要病原菌(如肠球菌、大肠埃希菌及肠杆菌)差异性较大(P<0.05);而葡萄球菌、变形菌、铜绿假单胞菌及肺炎克雷伯菌在两组间差异性较小(P>0.05)。基于药敏结果的抗菌药物方案疗效方面,NDSU组有效率显著高于DFI组(χ^(2)=4.045,P=0.044)。结论DFU患者营养状况较非糖尿病下肢皮肤溃疡患者差,创面感染程度较重,感染病原菌种类分布与药物敏感性以及抗感染疗效存在差异。
Objective To understand differences in the distribution of infectious pathogens and their antibiotic resistance characteristics in the wounds of diabetic foot ulcers(DFU)and lower limb skin ulcers in non-diabetic patients.Methods A total of 363 cases of DFU patients with infection hospitalized in the Department of Endocrinology and Metabolism of the First Affiliated Hospital of Anhui Medical University from July 2021 to June 2023 were selected(DFI group),and 100 non-diabetic lower limb skin ulcer patients with infection hospitalized in the hospital during the same period were selected as control group(NDSU group).A retrospective analysis of the clinical and laboratory data of participants in the DFI group and the NDSU group was conducted,and the distribution and antibiotic resistance characteristics of pathogens cultured from ulcer wounds between the two groups were compared.Results(1)The age,fasting blood glucose,white blood cell count,and C-reactive protein of the DFI group were significantly higher than those of the NDSU group(P<0.01),while hemoglobin,albumin,and ankle brachial index were significantly lower than those of the NDSU group(P<0.01).There was no statistically significant difference in ulcer course and gender composition between the two groups(P>0.05).(2)The mixed infection proportion in the DFI group was 65.8%,significantly higher than that in the NDSU group(38.0%)(χ^(2)=25.284,P<0.001).(3)The top five pathogens detected in the DFI group were Staphylococcus aureus,Enterococcus,Escherichia coli,Proteus mirabilis,and Pseudomonas aeruginosa.However,the top five pathogens detected in the NDSU group were Staphylococcus aureus,Pseudomonas aeruginosa,Klebsiella pneumoniae,Enterobacter,and Proteus mirabilis.There were statistically significant differences between the DFI group and the NDSU group in terms of the main types of pathogenic bacteria.The detection rate of Gram positive bacteria in the DFI group was significantly higher than that in the NDSU group(χ^(2)=12.501,P<0.01),while the detection rate of Gram negative bacteria was significantly lower than that in the NDSU group(χ^(2)=10.418,P<0.01).(4)In terms of drug sensitivity,there was a significant difference in the main pathogenic bacteria(such as Enterococcus,Escherichia coli,and Enterobacter)between the DFI group and the NDSU group(P<0.05);however,the differences in Staphylococcus aureus,Proteus mirabilis,Pseudomonas aeruginosa,and Klebsiella pneumoniae between the two groups were relatively small(P>0.05).In terms of the efficacy of antibacterial drug regimens based on drug sensitivity results,the effective rate in the NDSU group was significantly higher than that in the DFI group(χ^(2)=4.045,P=0.044).Conclusion Patients with DFU have poorer nutritional status and more severe wound infections compared to patients with non-diabetic lower limb skin ulcers.There are differences in the distribution of infectious pathogens,drug sensitivity,and the efficacy of anti-infection treatments between the two groups.
作者
於珍宜
陈明卫
YU Zhenyi;CHEN Mingwei(Department of General Practice,The First Affiliated Hospital of Anhui Medical University,Hefei 230032,Anhui,China;Department of Endocrinology and Metabolism,The First Affiliated Hospital of Anhui Medical University,Hefei 230032,Anhui,China;Graduate School,Anhui Medical University,Hefei 230032,Anhui,China)
出处
《右江医学》
2025年第5期398-405,共8页
Chinese Youjiang Medical Journal
基金
安徽省自然科学基金(2108085MH269)。
关键词
糖尿病
糖尿病足溃疡
病原菌
耐药性
diabetes mellitus
diabetic foot ulcer(DFU)
pathogenic bacteria
drug resistance
