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目的研究糖尿病足感染多药耐药菌(MDRMs)分布特点、耐药性及其危险因素,为临床治疗提供依据。方法选取2013年12月-2015年12月医院收治的糖尿病足患者290例,培养患者感染部位分泌物的细菌,分析MDRNs感染率,并对MDRNs分离菌株进行药敏试验,分析培养结果,并应用Logistics回归分析糖尿病足MDRMs的危险因素。结果 130例患者检测出MDRMs,MDRMs阳性率为44.8%,共分离出159株MDRMs,以金黄色葡萄球菌、铜绿假单胞菌和大肠埃希菌为主;金黄色葡萄球菌对苯唑西林、氨苄西林/舒巴坦和头孢唑林耐药率高达100.0%,大肠埃希菌对氨苄西林、哌拉西林/他唑巴坦、头孢噻吩、头孢曲松耐药率高达100.0%,logistics多因素回归分析显示,既往使用抗菌药物、因同一伤口住院超过2次/年、合并骨髓炎、应用第3代头孢菌素、神经缺血性伤口是导致糖尿病足MDRMs的危险因素(P<0.05)。结论糖尿病足感染MDRMs以金黄色葡萄球菌最常见,既往使用抗菌药物、因同一伤口住院超过2次/年、合并骨髓炎、应用第3代头孢菌素、神经缺血性伤口是导致糖尿病足MDRMs感染的危险因素。
Objective To study the distribution, drug resistance and risk factors of multidrug-resistant bacteria (MDRMs) in diabetic foot and provide basis for clinical treatment. Methods 290 patients with diabetic foot admitted from December 2013 to December 2015 in our hospital were enrolled in this study. Bacteria were collected from patients infected with secretions. The infection rate of MDRNs was analyzed. The susceptibility test of MDRNs isolates was carried out. The results of culture were analyzed and applied Logistics regression analysis of risk factors for diabetic foot MDRMs. Results The MDRMs were detected in 130 patients. The positive rate of MDRMs was 44.8%. A total of 159 MDRMs were isolated, mainly Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli. Staphylococcus aureus was sensitive to oxacillin, Ampicillin / sulbactam and cefazolin were as high as 100.0%. Escherichia coli was resistant to ampicillin, piperacillin / tazobactam, cefalotin and ceftriaxone as high as 100.0% Regression analysis showed that the previous antimicrobial agents were hospitalized for more than 2 times per year in the same wound with osteomyelitis. The third generation cephalosporins and ischemic wounds were the risk factors of MDRMs in diabetic foot (P <0.05). Conclusion Staphylococcus aureus is the most common form of MDRMs infected with diabetic foot. Previous antibacterials were used. The same wounds were hospitalized more than 2 times per year with osteomyelitis. Third-generation cephalosporins and ischemic wounds were the main cause of MDRMs in diabetic foot Risk factors for infection.