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达卡一家三级护理医院收治的糖尿病患者的感染模式及抗生素敏感性

Pattern of Infections and Antibiotic Sensitivity in Diabetic Patients Admitted in A Tertiary Care Hospital in Dhaka.

作者信息

Chowdhury S, Hasan M, Mondal G, Naznin J, Pathan M F

机构信息

Dr Sharmin Chowdhury, Medical Officer, National Institute of Neurosciences & Hospital (NINS&H), Dhaka, Bangladesh; E-mail:

出版信息

Mymensingh Med J. 2020 Oct;29(4):920-925.

Abstract

Infections are well recognized cause of morbidity and mortality in people with diabetes. This study was done to observe the pattern of infections and microorganism with sensitivity pattern in patients with diabetes admitted at a specialized referral hospital in Dhaka. This cross-sectional study was carried out in Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital, Dhaka from March 2014 to April 2015. It included 309 patients of diabetes (male-169, female-140; age mean±SD- 49.3±14.7 years) admitted in medicine or endocrinology department, who were screened for clinical evidence of infections according to revised McGeer criteria. Culture and sensitivity pattern of responsible microorganisms were sought from clinically appropriate specimen. Among the participants 25.9% (80 out of 309) had evidence of infection. The most common of them were urinary tract infection (53.8%) and respiratory tract infection (30.0%). E. coli and Klebsiella were the most common organisms that were isolated by urine (55.3% and 13.2%) and blood culture (57.1% and 42.9%). Acinetobacter was the most common pathogen in tracheal aspirate (80%) and Klebsiella in sputum (100%). Culture of wound swab exclusively revealed growth of Staphylococcus. E. coli was fairly sensitive to meropenem (100%), amikacin (93.5%) and nitrofurantoin (93.1%), while sensitivity of Klebsiella was almost similar to that of E. coli. Acinetobacter was fully resistant to ceftazidime, nitrofurantoin and meropenem while only modestly sensitive to ciprofloxacin and amikacin (25% and 20% respectively). Pseudomonas was 100% sensitive to ceftazidime, amikacin and meropenem, but 100% resistant to ciprofloxacin and nitrofurantoin. One in four admitted diabetes patient had evidence of infection, most commonly involving urinary and respiratory tracts. E. coli and Klebsiella both fairly sensitive to common antibiotics, were common isolates from urine and blood culture; whereas Acinetobacter isolated from tracheal aspirates and urine, was only modestly sensitive.

摘要

感染是糖尿病患者发病和死亡的公认原因。本研究旨在观察达卡一家专科医院收治的糖尿病患者的感染模式、微生物及其药敏模式。这项横断面研究于2014年3月至2015年4月在达卡的孟加拉国糖尿病、内分泌和代谢紊乱研究与康复研究所(BIRDEM)总医院开展。研究纳入了309例入住内科或内分泌科的糖尿病患者(男性169例,女性140例;年龄均值±标准差为49.3±14.7岁),根据修订的McGeer标准对其进行感染临床证据筛查。从临床合适的标本中寻找致病微生物的培养及药敏模式。在参与者中,25.9%(309例中的80例)有感染证据。其中最常见的是尿路感染(53.8%)和呼吸道感染(30.0%)。大肠埃希菌和克雷伯菌是尿液(55.3%和13.2%)和血培养(57.1%和42.9%)中最常分离出的微生物。不动杆菌是气管吸出物中最常见的病原体(80%),克雷伯菌是痰中最常见的病原体(100%)。伤口拭子培养仅显示有葡萄球菌生长。大肠埃希菌对美罗培南(100%)、阿米卡星(93.5%)和呋喃妥因(93.1%)相当敏感,而克雷伯菌的敏感性与大肠埃希菌几乎相似。不动杆菌对头孢他啶、呋喃妥因和美罗培南完全耐药,而对环丙沙星和阿米卡星仅中度敏感(分别为25%和20%)。铜绿假单胞菌对头孢他啶、阿米卡星和美罗培南100%敏感,但对环丙沙星和呋喃妥因100%耐药。四分之一的住院糖尿病患者有感染证据,最常见的是泌尿系统和呼吸道感染。大肠埃希菌和克雷伯菌对常用抗生素均相当敏感,是尿液和血培养中常见的分离菌;而从气管吸出物和尿液中分离出的不动杆菌仅中度敏感。

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