U.O. Malattie Infettive, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
Diabetes Res Clin Pract. 2011 Oct;94(1):133-9. doi: 10.1016/j.diabres.2011.07.017. Epub 2011 Aug 6.
Samples from 1295 patients with diabetic foot infection were evaluated; 4332 samples were collected with an average of 3.3 samples per patient. Fifty-seven percent of patients had a 2B ulcer and 23% had a 3B ulcer according to Texas University Classification. In 64.2% of samples collected at first visit an etiologic agent was identified. About 40% of the positive samples were polymicrobial. Gram positive bacteria were more frequently isolated (52.6%), Staphylococcus aureus was the most frequently isolated single agent (29.9%) and MRSA was 22% of S. aureus. Enterococcus spp., mainly Enterococcus faecalis, were 9.9%, all vancomycin susceptible except 2 isolates. Streptococci were 4.6%, more than 60% Streptococcus agalactiae. Gram negative rods were 40.6%, with enterobacteria 23.5% and Pseudomonas aeruginosa 10.3%. Anaerobes were only 0.3%, probably due to culture methods applied in our laboratory. Cotrimoxazole, rifampin and doxycycline were still active against S. aureus. ESBL producers, among enterobacteria, were 10%, mainly Escherichia coli and Proteus spp. Only colistin had a rate of susceptibility against P. aeruginosa above 90%. Levofloxacin had the best clinical activity with respect to the other quinolones, but when it failed, selected more resistant strains with respect to moxifloxacin among S. aureus and with respect to ciprofloxacin among P. aeruginosa.
对 1295 例糖尿病足感染患者的样本进行了评估；每位患者平均采集 3.3 份样本，共采集了 4332 份样本。根据德克萨斯大学分类法，57%的患者有 2B 溃疡，23%的患者有 3B 溃疡。在首次就诊时采集的 64.2%的样本中确定了病原体。约 40%的阳性样本为混合感染。革兰氏阳性菌的分离率较高（52.6%），金黄色葡萄球菌是最常分离到的单一病原体（29.9%），耐甲氧西林金黄色葡萄球菌（MRSA）占金黄色葡萄球菌的 22%。肠球菌属，主要为粪肠球菌，占 9.9%，除 2 株外均对万古霉素敏感。链球菌属占 4.6%，超过 60%为无乳链球菌。革兰氏阴性杆菌占 40.6%，其中肠杆菌科占 23.5%，铜绿假单胞菌占 10.3%。厌氧菌仅占 0.3%，可能是由于我们实验室应用的培养方法。复方磺胺甲噁唑、利福平、多西环素对金黄色葡萄球菌仍有活性。肠杆菌科中 ESBL 产生菌占 10%，主要为大肠埃希菌和变形杆菌属。只有黏菌素对铜绿假单胞菌的敏感性率高于 90%。左氧氟沙星在其他喹诺酮类药物中具有最佳的临床疗效，但当它失败时，与莫西沙星相比，金黄色葡萄球菌中更耐药的菌株，与环丙沙星相比，铜绿假单胞菌中更耐药的菌株。
