糖尿病足患者金黄色葡萄球菌感染率和耐药性分析
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摘要
目的调查糖尿病足患者金黄色葡萄球菌感染率及其耐药情况,为临床合理使用抗菌药物提供实验依据。方法回顾性分析2014年4月至2017年4月门诊及住院141例糖尿病足感染患者临床资料,采集患者伤口分泌物标本,采用全自动细菌鉴定分析系统鉴定金黄色葡萄球菌,并采用K-B纸片琼脂扩散法进行药物敏感试验,分析金黄色葡萄球菌检出率及抗菌药物耐药率。结果 141例标本中,检出金黄色葡萄球菌52株(36.9%),其中耐甲氧西林金黄色葡萄球菌(MRSA) 30株(57.7%),甲氧西林敏感金黄色葡萄球菌(MSSA) 22株(42.3%); MRSA对阿莫西林/克拉维酸钾、氨苄西林/舒巴坦、头孢曲松等抗生素的耐药率明显高于MSSA菌株,差异有统计学意义(P<0. 05)。结论糖尿病足患者伤口金黄色葡萄球菌感染率高,大部分为MRSA,且为多重耐药菌。
Objective To investigate the infection rate and drug resistance ofstaphylococcus aureus( SAU) in diabetic foot( DF) patients and provide experimental basis for rational use of antibacterial drugs in clinical practice. Methods Secretion samples of DF patients were collected from April 2014 to April 2017. Staphylococcus aureus stains were separated by automatic bacterial identification and analyzed their system. The drug sensitivity tests wer performed by Kirby-Bauer paper agar diffusion method. Results A total of 52 strains of SAU were detected from 141 secretion samples from DF patients,and shown with 36.9% detection rate. Among them,30 strains were methicillin-resistant staphylococcus aureus( MRSA)( 57.7%),and 22 stains were methicillin sensitive staphylococcus aureus( MSSA)( 42. 3%). MRSA had higher drug resistance rate to levofloxacin, amoxicillin/clavulanate potassium,ampicillin/Sulbactam and ceftriaxone than MSSA( P<0. 05). Conclusion The rate of staphylococcus aureus caused wound infection was high in diabetic food patients,most of the pathogens were MRSA with multi-drug resistance.
Objective To investigate the infection rate and drug resistance ofstaphylococcus aureus( SAU) in diabetic foot( DF) patients and provide experimental basis for rational use of antibacterial drugs in clinical practice. Methods Secretion samples of DF patients were collected from April 2014 to April 2017. Staphylococcus aureus stains were separated by automatic bacterial identification and analyzed their system. The drug sensitivity tests wer performed by Kirby-Bauer paper agar diffusion method. Results A total of 52 strains of SAU were detected from 141 secretion samples from DF patients,and shown with 36.9% detection rate. Among them,30 strains were methicillin-resistant staphylococcus aureus( MRSA)( 57.7%),and 22 stains were methicillin sensitive staphylococcus aureus( MSSA)( 42. 3%). MRSA had higher drug resistance rate to levofloxacin, amoxicillin/clavulanate potassium,ampicillin/Sulbactam and ceftriaxone than MSSA( P<0. 05). Conclusion The rate of staphylococcus aureus caused wound infection was high in diabetic food patients,most of the pathogens were MRSA with multi-drug resistance.
引文
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[18]闫振成.糖尿病足的诊治进展[J].重庆医科大学学报,2017,42(3):263-267.
[19]乐忠宏,汤晓姣,崔婷婷,等.糖尿病足感染患者病原学特点及耐药性分析[J].中华医院感染学杂志,2017,27(3):590-592,601.
[20]杨雪,孙晓菲,范慧洁,等.糖尿病足患者多药耐药菌感染的危险因素logistic回归分析[J].中华医院感染学杂志,2017,27(4):815-818.
[21]周利希,周秋红,陈玉华,等.糖尿病足多药耐药菌感染分析及控制策略[J].中国现代医学杂志,2014,24(21):80-83.
[22]Derese B,Kedir H,Teklemariam Z,et al.Bacterialprofile of urinary tract infection and antimicrobial susceptibility pattern among pregnant women attending at Antenatal Clinic in Dil Chora Referral Hospital,Dire Dawa,Eastern Ethiopia[J].Ther Clin Risk Manag,2016,18(12):251-260.
[2]葛均波,徐永健.内科学[M].8版.北京:人民卫生出版社,2013:739.
[3]Haleem A,Schultz JS,Heilmann KP,et al.Concordance of nasal and diabetic footulcer staphylococcal colonization[J].Diagn Microbiol Infect Dis,2014,79(1):85-89.
[4]郑丛丛,王鹏华,褚月颉,等.糖尿病足溃疡合并外周动脉病变患者运动处方的有效性及安全性研究[J].中华内分泌代谢杂志,2013,29(1):18-23.
[5]叶应妩,王毓三.全国临床检验操作规程[M].4版.北京:人民卫生出版社,2015:578-579.
[6]Clinical and Laboratory Standards Institute.Performance Standards For Antimicrobial Susceptibility Testing;Twentyfifth Informationgal Supplement[S].Document M100-S25.Wayne,PA:CLSI,2015.
[7]Mertz L.One Step at a Time:Making strides toward a solution for the diabetic foot problem[J].IEEE Pulse,2014,5(3):35-39.
[8]陈海燕,宝轶,叶菲,等.老年2型糖尿病患者胰岛素样生长因子1及胱抑素C与糖尿病肾病的关系[J].中华老年心脑血管病杂志,2015,17(4):342-345.
[9]赵满红,郑双双,王兆品,等.宁波市某社区糖尿病患者血糖控制的影响因素分析[J].中国预防医学杂志,2016,17(3):187-192.
[10]邸铁涛,张春玲,陈露,等.糖尿病足溃疡的发病机制及难愈合原因分析[J].贵阳中医学院学报,2017,39(1):98-101.
[11]Sato A.The necessity and effectiveness of mineralocorticoid receptor antagonist in the treatment of diabetic nephropathy[J].Hypertens Res,2015,38(6):367-374.
[12]张旭环,方辉,王辉.糖尿病肾病患者感染导致急性肾损伤临床分析[J].中华医院感染学杂志,2015,25(14):3238-3240.
[13]徐涛,石梅,邱云霞,等.终末期糖尿病肾病患者医院感染病原菌分布与耐药性分析[J].中华医院感染学杂志,2015,25(17):3884-3886.
[14]Joseph WS,Quast T,Cogo A,et al.Daptomycin for methicillin-resistant Staphylococcus aureus diabetic foot in fections[J].J Am Podiatr Med Assoc,2014,104(2):159-168.
[15]吴金凤,程桂娥,张林,等.2014年医院感染现患率调查分析[J].东南国防医药,2016,18(5):515-518.
[16]Shiau MY,Lee MS,Huang TL,et al.Mycobacterial prevalence and antibiotic resistance frequency trends in Taiwan of mycobacterial clinical isolates from 2002 to 2014[J].Medicine(Baltimore),2016,95(12):2942.
[17]Lubin AS,Snydman DR,Ruthazer R,et al.Predicting high vancomycin minimum inhibitory concentration in methicillin resistant Staphylococcus aureus bloodstream infections[J].Clin Infect Dis,2011,52(8):997-1002.
[18]闫振成.糖尿病足的诊治进展[J].重庆医科大学学报,2017,42(3):263-267.
[19]乐忠宏,汤晓姣,崔婷婷,等.糖尿病足感染患者病原学特点及耐药性分析[J].中华医院感染学杂志,2017,27(3):590-592,601.
[20]杨雪,孙晓菲,范慧洁,等.糖尿病足患者多药耐药菌感染的危险因素logistic回归分析[J].中华医院感染学杂志,2017,27(4):815-818.
[21]周利希,周秋红,陈玉华,等.糖尿病足多药耐药菌感染分析及控制策略[J].中国现代医学杂志,2014,24(21):80-83.
[22]Derese B,Kedir H,Teklemariam Z,et al.Bacterialprofile of urinary tract infection and antimicrobial susceptibility pattern among pregnant women attending at Antenatal Clinic in Dil Chora Referral Hospital,Dire Dawa,Eastern Ethiopia[J].Ther Clin Risk Manag,2016,18(12):251-260.
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