中国南方地区糖尿病足感染患者的微生物分布及药敏情况。
Distribution of microbes and antimicrobial susceptibility in patients with diabetic foot infections in South China.
机构信息
Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
出版信息
Front Endocrinol (Lausanne). 2023 Jan 24;14:1113622. doi: 10.3389/fendo.2023.1113622. eCollection 2023.
BACKGROUND
To investigate the distribution of microbes and drug susceptibility in patients with diabetic foot infections (DFI) and provide guidance for clinical empirical treatment and the rational selection of antibacterial drugs.
METHODS
Retrospective analysis of the pathogenic bacterium distribution and antimicrobial susceptibility isolated from 581 DFI patients with different Wagner grades.
RESULTS
The 534 positive samples included 473 cases (88.58%)) of monomicrobial infections and 61 cases (11.42%) of polymicrobial infections before antibiotic therapy. A total of 656 strains were cultivated, including 387 (58.99%) strains of gram-positive organisms (GPOs), 235 (35.82%) gram-negative bacilli (GNB), and 21 (3.20%) fungal strains. Polymicrobial infections mainly occurred in patients with Wagner grade 3-4 ulcers. GPOs were predominant in Wagner grades 1-3 (grade 1: 96.67%, grade 2: 76.52%, grade 3 62.81%), and the most common was Staphylococcus aureus (grade 1: 31.66%, grade 2: 33.04%, grade 3 35.53%). GNB were predominant in grades 4-5 (grade 4: 51.46%, grade 5:60%), and the most common GNB in Wagner grades 4-5 was (grade 4:27.88%, grade 5: 42.86%), while the most common GPO was (grade 4:34.48%, grade 5:25.00%). Staphylococcus (including MRSA) and Enterococcus were still highly sensitive to vancomycin, linezolid, and tigecycline. Most GNB were still highly sensitive to meropenem, tigecycline, ertapenem, and amikacin. was most sensitive to amikacin (97.14%), followed by meropenem (92%) and ertapenem (80%).
CONCLUSION
The distribution of microbes and antimicrobial susceptibility in DFI patients varied with different Wagner grades. The most appropriate antimicrobial therapy should be selected based on the pathogen culture and antimicrobial susceptibility.
背景
为了调查糖尿病足感染（DFI）患者中微生物的分布和药物敏感性，为临床经验治疗和抗菌药物的合理选择提供指导。
方法
回顾性分析了不同 Wagner 分级的 581 例 DFI 患者的病原菌分布和抗菌药物敏感性。
结果
在抗生素治疗前，534 例阳性样本中包括 473 例（88.58%）单微生物感染和 61 例（11.42%）多微生物感染。共培养出 656 株，其中革兰阳性菌（GPO）387 株（58.99%），革兰阴性杆菌（GNB）235 株（35.82%），真菌 21 株（3.20%）。混合感染主要发生在 Wagner 分级 3-4 溃疡的患者中。GPO 在 Wagner 分级 1-3 中占优势（分级 1：96.67%，分级 2：76.52%，分级 3：62.81%），最常见的是金黄色葡萄球菌（分级 1：31.66%，分级 2：33.04%，分级 3：35.53%）。GNB 在分级 4-5 中占优势（分级 4：51.46%，分级 5：60%），Wagner 分级 4-5 中最常见的 GNB 是 （分级 4：27.88%，分级 5：42.86%），而最常见的 GPO 是 （分级 4：34.48%，分级 5：25.00%）。金黄色葡萄球菌（包括 MRSA）和肠球菌对万古霉素、利奈唑胺和替加环素仍然高度敏感。大多数 GNB 对美罗培南、替加环素和厄他培南仍然高度敏感。对阿米卡星（97.14%）最敏感，其次是美罗培南（92%）和厄他培南（80%）。
结论
DFI 患者中微生物的分布和抗菌药物敏感性随 Wagner 分级的不同而不同。应根据病原菌培养和药敏试验选择最合适的抗菌治疗方案。
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