Petrovici Cristina Gabriela, Dorobăt Carmen, Bejan Codrina, Juganariu Gabriela, Simiraş Eliza, Filip Olga, Luca V, Miftode Egidia
Facultatea de Medicină, Universitatea de Medicină şi Farmacie "Gr. T. Popa" Iaşi.
Rev Med Chir Soc Med Nat Iasi. 2011 Oct-Dec;115(4):1035-41.
Infections in the diabetic population can be severe and life threatning at least for two reasons: clinical signs are often torpid, masqued by chronical complications of diabetes leading to late recognition and medical adresability and also because of the inability to control established infection due to complex cell-mediated and humoral immunity deffects. The aim of the study was to evaluate the etiology, clinical features and outcome in diabetic patients with invazive disease.
A retrospective study was conducted between January 2008 and December 2010 at The Clinical Hospital of Infectious Diseases Iaşi among 75 diabetic patients with sepsis of microbiologically confirmed etiology (positive cultures from normally sterile sites) and sepsis with clinically suspected etiology (positive cultures from pus). Cases with positive urocultures and coprocultures only, were excluded.
From 75 diabetics, 56% were males, 90,7% being over 50 years. Severe cases of sepsis (33/75, 44%) were associated more often with insulin-treated diabetes than non-insulin treated group (40% vs. 4%, p<0,005) probably because of multiple comorbidities associated as suggested by a high Charlson score (6,09 vs. 4,09, p<0,05). There were 64 cases with confirmed etiology and 11 cases with clinically suspected etiology. Staphylococcus aureus and Escherichia coli were the most common agents isolated, being involved in 16 (21,3%) cases each, followed by coagulase negative Staphylococci (14/18,66%), Enterococcus spp.(6/8%), group B Streptococcus (3/4%), Streptococcus pneumoniae, Enterobacter spp., Salmonella spp. (2/2,66% each), Aerococcus viridans, Streptococcus equi, Klebsiella pneumoniae, Neisseria meningitidis, Sphyngomonas paucimobilis, Pseudomonas aeruginosa, Proteus mirabilis (1/1,33%). Multiple septic disseminations occured in 17(22,6%) cases and meningeal involvment was doccumented in 10(15,6%) cases. Meticillin resistance was noted in 53,3% for invasive isolates of S. aureus. Among 16 invazive strains of E. coli, 25% were resistant to 3rd generation cephalosporins, 17% to ciprofloxacin and 6,6% to aminoglycosides and colimycin. There were no E. coli strains resistant to imipenem, piperacillin-tazobactam and aztreonam. The mean mortality rate was 14,66%.
The high level of resistance of S. aureus and E. coli to commonly used antibiotics and meningeal involvement imposes a multidisciplinary approach of the diabetic patient. Proper knowledge of the pathogers involved in the potential invazive diseases is an important tool for successful treatment with appropriate empirical broad-spectrum antimicrobial agents.
糖尿病患者的感染可能很严重，甚至危及生命，至少有两个原因：临床症状往往不明显，被糖尿病的慢性并发症掩盖，导致诊断延迟和治疗不及时；此外，由于复杂的细胞介导和体液免疫缺陷，已有的感染难以控制。本研究的目的是评估糖尿病侵袭性疾病患者的病因、临床特征和预后。
2008年1月至2010年12月在雅西传染病临床医院对75例糖尿病患者进行了回顾性研究，这些患者患有微生物学确诊病因的败血症（来自正常无菌部位的培养阳性）和临床疑似病因的败血症（来自脓液的培养阳性）。仅尿培养和粪便培养阳性的病例被排除。
75例糖尿病患者中，56%为男性，90.7%年龄超过50岁。严重败血症病例（33/75，44%）与胰岛素治疗的糖尿病相关性更高，而非胰岛素治疗组（40%对4%，p<0.005），这可能是由于高查尔森评分提示的多种合并症（6.09对4.09，p<0.05）。有64例病因确诊，11例临床疑似病因。金黄色葡萄球菌和大肠杆菌是最常见的分离病原体，各占16例（21.3%），其次是凝固酶阴性葡萄球菌（14/18.66%）、肠球菌属（6/8%）、B组链球菌（3/4%）、肺炎链球菌、肠杆菌属、沙门菌属（各2/2.66%）、绿色气球菌、马链球菌、肺炎克雷伯菌、脑膜炎奈瑟菌、少动鞘氨醇单胞菌、铜绿假单胞菌、奇异变形杆菌（各1/1.33%）。17例（22.6%）发生了多发性败血症播散，10例（15.6%）有脑膜受累记录。侵袭性金黄色葡萄球菌分离株中53.3%对甲氧西林耐药。在16株侵袭性大肠杆菌中，25%对第三代头孢菌素耐药，17%对环丙沙星耐药，6.6%对氨基糖苷类和黏菌素耐药。没有对亚胺培南、哌拉西林-他唑巴坦和氨曲南耐药的大肠杆菌菌株。平均死亡率为14.66%。
金黄色葡萄球菌和大肠杆菌对常用抗生素的高耐药性以及脑膜受累要求对糖尿病患者采取多学科方法。正确了解潜在侵袭性疾病中涉及的病原体是使用适当的经验性广谱抗菌药物成功治疗的重要工具。
