Vinodkumar Chickmagalure Shivaswamy, Hiresave Srinivasa, Kandagal Giriyapal Basavarajappa, Bandekar Nitin
Indian J Surg. 2011 Aug;73(4):291-4. doi: 10.1007/s12262-011-0287-5. Epub 2011 May 3.
Pseudomonas aeruginosa strains that produce metallo beta lactamases (MBLs) are becoming increasingly prevalent in wound infections. The aim of the present study is to determine the clinical features, incidence, and to find out the antimicrobial susceptibility pattern of Pseudomonas aeruginosa in diabetic foot infections. Pus samples for bacterial culture were collected from 310 patients admitted with diabetic foot infections. Antimicrobial sensitivity testing was performed by the Kirby-Bauer disc diffusion method. Carbapenem resistance screening and confirmation of MBL was done by the modified imipenem-ethylenediaminetetraacetic acid (EDTA) double disc synergy test. A total of 54 Pseudomonas aeruginosa was isolated from 310 diabetic foot cases. Males were affected more than females with an M:F ratio of 1.6:1. Most patients belonged to the fifth decade of life with a mean age of 49 ± 16.8 years. All the patients were previously diagnosed with diabetes mellitus with duration of the disease at 16 ± 10.2 years and 63% were prescribed oral hypoglycaemic agents. Wound characteristics were classified according to Wagner's classification majority of Pseudomonas aeruginosa were isolated from Wagner's II and III grade wound. A number of 26 (89.7%) patients underwent debridement, while 9 (31%) patients underwent toe disarticulation, and 7 (24.1%) patients underwent below-the-knee (BKA) amputation. Antibiotic sensitivity testing revealed 20.3% of Pseudomonas aeruginosa were resistance to carbapenem and 81.8% of these were MBL mediated resistance. Infection with multi drug resistance organisms (MDROs) is common in diabetic foot ulcers and is associated with inadequate glycemic control and increased requirement for surgical treatment. There is a need for continuous surveillance of resistant bacteria to provide the basis for empirical therapy and reduce the risk of complications.
产金属β-内酰胺酶（MBLs）的铜绿假单胞菌菌株在伤口感染中日益普遍。本研究的目的是确定糖尿病足感染中铜绿假单胞菌的临床特征、发病率，并找出其抗菌药敏模式。从310例因糖尿病足感染入院的患者中采集脓性样本进行细菌培养。采用 Kirby-Bauer 纸片扩散法进行抗菌药敏试验。通过改良亚胺培南-乙二胺四乙酸（EDTA）双纸片协同试验进行碳青霉烯耐药筛选和MBL确认。从310例糖尿病足病例中共分离出54株铜绿假单胞菌。男性感染人数多于女性，男女比例为1.6:1。大多数患者年龄在五十岁左右，平均年龄为49±16.8岁。所有患者既往均被诊断为糖尿病，病程为16±10.2年，63%的患者曾服用口服降糖药。根据瓦格纳分类法对伤口特征进行分类，大多数铜绿假单胞菌分离自瓦格纳Ⅱ级和Ⅲ级伤口。26例（89.7%）患者接受了清创术，9例（31%）患者接受了截趾术，7例（24.1%）患者接受了膝下截肢术（BKA）。抗生素药敏试验显示，20.3%的铜绿假单胞菌对碳青霉烯耐药，其中81.8%为MBL介导的耐药。糖尿病足溃疡中多重耐药菌（MDROs）感染很常见，且与血糖控制不佳和手术治疗需求增加有关。需要持续监测耐药菌，为经验性治疗提供依据并降低并发症风险。
