糖尿病足溃疡细菌的分离与鉴定：截肢、抗生素耐药性及死亡率
Isolation and characterization of bacteria from diabetic foot ulcer: amputation, antibiotic resistance and mortality rate.
作者信息
Shaheen Muamar M A, Al Dahab Sewar, Abu Fada Maryiam, Idieis Rawand
机构信息
Clinical Pharmacy and Practice, Faculty of Pharmacy and Medical Sciences, Hebron University, P.O Box 40, Hebron, West Bank 00972 Palestine.
出版信息
Int J Diabetes Dev Ctries. 2022 Jul;42(3):529-537. doi: 10.1007/s13410-021-00997-7. Epub 2021 Sep 10.
BACKGROUND
Diabetic foot ulcer (DFU) is one of the most serious complications of diabetes mellitus with devastating outcomes. Poorly treated DFU leads to osteomyelitis, gangrene and limb amputation. There is an increased risk of mortality for the amputees and increased number of bacterial resistance in survived patients. Struggle on choice of the best antibiotic(s) for DFU is escalating.
OBJECTIVES
To determine risk factors associated with mortality in patients with DFU. To investigate bacterial drug resistance in survived or deceased patients around amputation.
METHODOLOGY
This is a retrospective cohort study that involved all diabetic patients who had DFU or minor or major amputation at Hebron Governmental Hospital from 2013 to 2020. Antibiotic use and bacterial isolates along with culture and sensitivity test results were retrieved from patients' profiles and laboratory records. Major outcome of study was survival rate around amputation. Patients who missed test results for FBS or HbAc1, or who had no wound culture were excluded. SPSS version 22 was used to analyze data.
RESULTS
Eighty four subjects were included in this study, 64.8 ± 12.58 years old, 63.1% males who had diabetic foot ulcer, minor or major limb amputation between 2013 and 2020 at Hebron Governmental Hospital. Forty tow patients (50%) had diabetic foot ulcer, 28 patients (33.3%) had major limb amputation, and 14 patients (16.7%), succumbed to minor amputation. Average FBS was 292.8 ± 136.33 mg/dl and average HbA1C was 8.55 ± 1.89%. Mortality rate was 9.5%. Using the Chi square test, we found a significant relationship between mortality and type of isolated bacteria, = 0.033 and between diabetic complications (nephropathy) and mortality, = 0.033. There was a significant relationship between antibiotic use and mortality, = 0.04, especially with metronidazole and colistin, if they were used around limb amputation.
CONCLUSIONS
Mortality of diabetic patients with DFU was associated with nephropathy and Acinetobacter or infections.
背景
糖尿病足溃疡（DFU）是糖尿病最严重的并发症之一，会导致毁灭性后果。DFU治疗不当会引发骨髓炎、坏疽和肢体截肢。截肢患者的死亡风险增加，存活患者的细菌耐药性也会增强。针对DFU选择最佳抗生素的斗争日益激烈。
目的
确定DFU患者死亡的相关危险因素。调查截肢前后存活或死亡患者的细菌耐药情况。
方法
这是一项回顾性队列研究，纳入了2013年至2020年在希布伦政府医院患有DFU或接受过小截肢或大截肢的所有糖尿病患者。从患者病历和实验室记录中获取抗生素使用情况、细菌分离株以及培养和药敏试验结果。研究的主要结局是截肢前后的生存率。排除空腹血糖（FBS）或糖化血红蛋白（HbAc1）检测结果缺失或未进行伤口培养的患者。使用SPSS 22版软件分析数据。
结果
本研究纳入了84名受试者，年龄为64.8±12.58岁，63.1%为男性，他们于2013年至2020年在希布伦政府医院患有糖尿病足溃疡、接受过小截肢或大截肢。42名患者（50%）患有糖尿病足溃疡，28名患者（33.3%）接受过大肢体截肢，14名患者（16.7%）死于小截肢。平均空腹血糖为292.8±136.33mg/dl，平均糖化血红蛋白为8.55±1.89%。死亡率为9.5%。通过卡方检验，我们发现死亡率与分离出的细菌类型之间存在显著关系（P = 0.033），糖尿病并发症（肾病）与死亡率之间也存在显著关系（P = 0.033）。抗生素使用与死亡率之间存在显著关系（P = 0.04），尤其是在肢体截肢前后使用甲硝唑和黏菌素时。
结论
患有DFU的糖尿病患者的死亡率与肾病以及不动杆菌或[此处原文缺失一种细菌名称]感染有关。
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