多药耐药菌对糖尿病足感染结局的影响。

Influence of multidrug resistant organisms on the outcome of diabetic foot infection.

机构信息

Istanbul University, Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.

Koc University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.

出版信息

Int J Infect Dis. 2018 May;70:10-14. doi: 10.1016/j.ijid.2018.02.013. Epub 2018 Feb 21.

DOI:10.1016/j.ijid.2018.02.013

PMID:29476898

Abstract

OBJECTIVES

We described the clinical outcomes of the diabetic patients who had foot infections with multidrug resistant organisms.

METHODS

We included the patients with diabetic foot infections (DFI) from 19 centers, between May 2011 and December 2015. Infection was defined according to IDSA DFI guidelines. Patients with severe infection, complicated moderate infection were hospitalized. The patients were followed-up for 6 months after discharge.

RESULTS

In total, 791 patients with DFI were included, 531(67%) were male, median age was 62 (19-90). Severe infection was diagnosed in 85 (11%) patients. Osteomyelitis was diagnosed in 291(36.8%) patients. 536 microorganisms were isolated, the most common microorganisms were S. aureus (20%), P. aeruginosa (19%) and E. coli (12%). Methicillin resistance (MR) rate among Staphylococcus aureus isolates was 31%. Multidrug resistant bacteria were detected in 21% of P. aeruginosa isolates. ESBL (+) Gram negative bacteria (GNB) was detected in 38% of E. coli and Klebsiella isolates. Sixty three patients (8%) were re-hospitalized. Of the 791 patiens, 127 (16%) had major amputation, and 24 (3%) patients died. In multivariate analysis, significant predictors for fatality were; dialysis (OR: 8.3, CI: 1.82-38.15, p=0.006), isolation of Klebsiella spp. (OR:7.7, CI: 1.24-47.96, p=0.028), and chronic heart failure (OR: 3, CI: 1.01-9.04, p=0.05). MR Staphylococcus was detected in 21% of the rehospitalized patients, as the most common microorganism (p<0.001).

CONCLUSION

Among rehospitalized patients, methicillin resistant Staphylococcus infections was detected as the most common agent, and Klebsiella spp. infections were found to be significantly associated with fatality.

摘要

目的

我们描述了患有多重耐药菌足部感染的糖尿病患者的临床结局。

方法

我们纳入了 2011 年 5 月至 2015 年 12 月期间来自 19 个中心的糖尿病足感染（DFI）患者。感染根据 IDSA DFI 指南定义。严重感染和复杂中度感染的患者住院治疗。患者在出院后随访 6 个月。

结果

共纳入 791 例 DFI 患者，其中 531 例（67%）为男性，中位年龄为 62 岁（19-90 岁）。85 例（11%）患者诊断为严重感染。291 例（36.8%）患者诊断为骨髓炎。分离出 536 种微生物，最常见的微生物是金黄色葡萄球菌（20%）、铜绿假单胞菌（19%）和大肠杆菌（12%）。金黄色葡萄球菌分离株中耐甲氧西林（MR）率为 31%。在 21%的铜绿假单胞菌分离株中检测到多药耐药菌。在 38%的大肠杆菌和克雷伯菌分离株中检测到 ESBL（+）革兰氏阴性菌（GNB）。63 例（8%）患者再次住院。在 791 例患者中，127 例（16%）行大截肢，24 例（3%）患者死亡。多变量分析显示，死亡的显著预测因素为：透析（OR：8.3，95%CI：1.82-38.15，p=0.006）、分离出克雷伯菌属（OR：7.7，95%CI：1.24-47.96，p=0.028）和慢性心力衰竭（OR：3，95%CI：1.01-9.04，p=0.05）。在再次住院的患者中，检测到 21%的耐甲氧西林金黄色葡萄球菌感染，是最常见的微生物（p<0.001）。