Department of Endocrinology, The Bethune International Peace Hospital, Shijiazhuang, China.
Department of Orthopaedics, The Gucheng County Hospital of Hebei Province, Gucheng, China.
Int Wound J. 2024 Apr;21(4):e14864. doi: 10.1111/iwj.14864.
Multidrug-resistant (MDR) bacterial infections have become increasingly common in recent years due to the increased prevalence of diabetic foot ulcers (DFUs). We carried out a meta-analysis aimed at investigating the prevalence of MDR bacteria isolated from DFUs and analysing the risk factors for MDR bacterial infection in patients with DFUs. The PubMed/Medline, Web of Science, Embase, Cochrane Library, Ovid, Scopus, and ProQuest databases were searched for studies published up to November 2023 on the clinical outcomes of MDR bacteria in DFUs. The main outcome was the prevalence of MDR bacteria in DFUs. A total of 21 studies were included, representing 4885 patients from which 2633 MDR bacterial isolates were obtained. The prevalence of MDR bacteria in DFUs was 50.86% (95% confidence interval (CI): 41.92%-59.78%). The prevalence of MDR gram-positive bacteria (GPB) in DFUs was 19.81% (95% CI: 14.35%-25.91%), and the prevalence of MDR gram-negative bacteria (GNB) in DFUs was 32.84% (95% CI: 26.40%-39.62%). MDR Staphylococcus aureus (12.13% (95% CI: 8.79%-15.91%)) and MDR Enterococcus spp. (3.33% (95% CI: 1.92%-5.07%)) were the main MDR-GPB in DFUs. MDR Escherichia coli, MDR Pseudomonas aeruginosa, MDR Enterobacter spp., MDR Klebsiella pneumoniae, and MDR Proteus mirabilis were the main MDR-GNB in DFUs. The prevalence rates were 6.93% (95% CI: 5.15%-8.95%), 6.01% (95% CI: 4.03%-8.33%), 3.59% (95% CI: 0.42%-9.30%), 3.50% (95% CI: 2.31%-4.91%), and 3.27% (95% CI: 1.74%-5.21%), respectively. The clinical variables of diabetic foot ulcer patients infected with MDR bacteria and non-MDR bacteria in the included studies were analysed. The results showed that peripheral vascular disease, peripheral neuropathy, nephropathy, osteomyelitis, Wagner's grade, previous hospitalization and previous use of antibacterial drugs were significantly different between the MDR bacterial group and the non-MDR bacterial group. We concluded that there is a high prevalence of MDR bacterial infections in DFUs. The prevalence of MDR-GNB was greater than that of MDR-GPB in DFUs. MDR S. aureus was the main MDR-GPB in DFUs, and MDR E. coli was the main MDR-GNB in DFUs. Our study also indicated that peripheral vascular disease, peripheral neuropathy, nephropathy, osteomyelitis, Wagner's grade, previous hospitalization, and previous use of antibacterial drugs were associated with MDR bacterial infections in patients with DFUs.
近年来，由于糖尿病足溃疡（DFU）的患病率增加，多药耐药（MDR）细菌感染变得越来越普遍。我们进行了一项荟萃分析，旨在调查从 DFU 分离的 MDR 细菌的患病率，并分析 DFU 患者中 MDR 细菌感染的危险因素。检索了截至 2023 年 11 月在 PubMed/Medline、Web of Science、Embase、Cochrane Library、Ovid、Scopus 和 ProQuest 数据库上发表的关于 MDR 细菌在 DFU 中临床结局的研究。主要结局是 DFU 中 MDR 细菌的患病率。共纳入 21 项研究，代表了 4885 名患者，从中获得了 2633 株 MDR 细菌分离株。DFU 中 MDR 细菌的患病率为 50.86%（95%置信区间：41.92%-59.78%）。DFU 中 MDR 革兰阳性菌（GPB）的患病率为 19.81%（95%置信区间：14.35%-25.91%），DFU 中 MDR 革兰阴性菌（GNB）的患病率为 32.84%（95%置信区间：26.40%-39.62%）。MDR 金黄色葡萄球菌（12.13%（95%置信区间：8.79%-15.91%））和 MDR 肠球菌属（3.33%（95%置信区间：1.92%-5.07%））是 DFU 中主要的 MDR-GPB。MDR 大肠埃希菌、MDR 铜绿假单胞菌、MDR 肠杆菌属、MDR 肺炎克雷伯菌和 MDR 奇异变形杆菌是 DFU 中主要的 MDR-GNB。患病率分别为 6.93%（95%置信区间：5.15%-8.95%）、6.01%（95%置信区间：4.03%-8.33%）、3.59%（95%置信区间：0.42%-9.30%）、3.50%（95%置信区间：2.31%-4.91%）和 3.27%（95%置信区间：1.74%-5.21%）。对纳入研究中感染 MDR 细菌和非 MDR 细菌的糖尿病足溃疡患者的临床变量进行了分析。结果表明，MDR 细菌组与非 MDR 细菌组在周围血管疾病、周围神经病变、肾病、骨髓炎、Wagner 分级、既往住院和既往使用抗菌药物方面差异有统计学意义。我们得出结论，DFU 中存在 MDR 细菌感染的高患病率。DFU 中 MDR-GNB 的患病率大于 MDR-GPB。MDR 金黄色葡萄球菌是 DFU 中主要的 MDR-GPB，MDR 大肠埃希菌是 DFU 中主要的 MDR-GNB。我们的研究还表明，周围血管疾病、周围神经病变、肾病、骨髓炎、Wagner 分级、既往住院和既往使用抗菌药物与 DFU 患者的 MDR 细菌感染有关。
