Huang Ying, Cao Ying, Zou Mengchen, Li Wenxia, Luo Xiangrong, Jiang Ya, Xue Yaoming, Gao Fang
Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China. E-mail:
Nan Fang Yi Ke Da Xue Xue Bao. 2015 Dec;35(12):1782-6.
To explore the distribution and antibiotic resistance of pathogens in lesions of diabetic foot osteomyelitis (DFO) and analyze the risk factors causing osteomyelitis.
A total of 372 patients with diabetic foot infections hospitalized between January 2011 and December 2014, including 203 with osteomyelitis (OM group) and 169 without osteomyelitis (non-OM group), were examined for the distribution and antibiotic resistance profile of the pathogens in the wounds. Logistic regression analysis was used to analyze the risk factors causing osteomyelitis.
Gram-negative bacteria were the predominant pathogens (53.7%) in the infected wounds in OM group, whereas Gram-positive bacteria were the most frequently found (56.7%) in non-OM group (P=0.001). Among the Gram-positive bacteria, Staphylococcus was the dominating flora (35.1%). The resistance rate to oxacillin and cefoxitin of the isolated bacteria in OM group (64.9% and 68.5%, respectively) was significantly higher than that in non-OM group (29.2% and 32.6%, respectively; P<0.05). Among the gram-negative bacteria, Enterobacteriaceae was the dominating flora (62.4%), with a higher resistance rate to Cefepime and Aztreonam in OM group (30.1% and 38.6%, respectively) than in non-OM group (15.1% and 22.2%, respectively; P<0.05). Logistic regression analysis indicated that the infection by multi-drug resistant bacteria and an wounds area >4 cm(2) were the risk factors for osteomyelitis in patients with diabetic foot infections (P<0.05).
In addition to an empirical anti-infection therapy, clinicians should choose specific antibiotics against Gram-negative bacteria according to the microbial spectrum and antibiotic resistance of pathogens in patients with DFO; patients with diabetic foot infections by multi-drug resistant bacteria and those with a wound area exceeding 4 cm(2) are exposed to an increased risk of osteomyelitis.
探讨糖尿病足骨髓炎（DFO）病灶中病原菌的分布及耐药情况，并分析导致骨髓炎的危险因素。
对2011年1月至2014年12月期间住院的372例糖尿病足感染患者进行研究，其中203例患有骨髓炎（OM组），169例未患骨髓炎（非OM组），检测伤口病原菌的分布及耐药情况。采用Logistic回归分析导致骨髓炎的危险因素。
OM组感染伤口中革兰阴性菌为主要病原菌（53.7%），而非OM组中革兰阳性菌最为常见（56.7%）（P = 0.001）。在革兰阳性菌中，葡萄球菌是主要菌群（35.1%）。OM组分离菌对苯唑西林和头孢西丁的耐药率（分别为64.9%和68.5%）显著高于非OM组（分别为29.2%和32.6%；P < 0.05）。在革兰阴性菌中，肠杆菌科是主要菌群（62.4%），OM组对头孢吡肟和氨曲南的耐药率（分别为30.1%和38.6%）高于非OM组（分别为15.1%和22.2%；P < 0.05）。Logistic回归分析表明，多重耐药菌感染和伤口面积>4 cm²是糖尿病足感染患者发生骨髓炎的危险因素（P < 0.05）。
除经验性抗感染治疗外，临床医生应根据DFO患者病原菌的菌谱和耐药情况选择针对革兰阴性菌的特异性抗生素；多重耐药菌感染的糖尿病足患者及伤口面积超过4 cm²的患者发生骨髓炎的风险增加。
