金黄色葡萄球菌感染的糖尿病足患者耐药特点及临床特征

摘要

Objective:To investigate clinical features and antibiotic resistance of staphyloccocus aureus(SA)strains isolated from patients with diabetic foot infections(DFI)in The second people’s hospital of Foshan.Method:33 SA strains were isolated from 132 patients with diabetic foot in the hospital from Jan 2010 to Dec 2012.The clinical features of patients were summarized. Relationships between the isolates and depth of ulcer or severity of infection were analyzed. The disk-diffusion method was performed to examine antimicrobial susceptibility. Result:Gram positive(G+)and Gram negative (G-)isolates were 56.1%and 43.9%,respectively. Multidrug-resistant SA composed 48.5%of the total SA isolates. The size of ulcers with SA infections was bigger than those with non-SA bacterial infections(P<0.05).Compared to G-strains,patients with SA strains were older;and more frequently,they had osteomyelitis.Compared to G-strains,the SA strains were more frequently isolated from deeper ulcers and with long-time infections(P<0.01).The resistant rates of SA to first generation cephalosporins,second generation cephalosporins,third generation cephalosporins,fluoroquinolones,and Large ring lactones were between 38.5%-58.8%,37.6%-63.2%,33.4%-62.7%,53.5%-68.9%,and 30.2%-44.3%,respectively.Only two out of 33 SA strains was vancomycin-resistant.Conclusion:SA strains are mainly found in patients with deeper ulcers and more serious infections.Multidrug-resistant SA is common in DFI.It is important to Isolate pathogens and determine their antibiotic resistance correctly in diabetic foot patients in order to provide appropriate drug administration and to reduce the production and dissemination of drug resistant strains.%　　目的：分析从糖尿病足感染创面分离的金黄色葡萄球菌（SA）的耐药特点及临床特征。方法：2010年1月-2012年12月从佛山市第二人民医院132例糖尿病足感染溃疡中分离出33株金黄色葡萄球菌，采用K-B纸片扩散法进行药敏试验，分析细菌耐药性，分析患者临床特点，总结耐药菌与溃疡深度、感染严重程度的相关性。结果：（1）132例糖尿病足感染患者中革兰氏阳性菌及革兰氏阴性菌检出率分别为56.1%和43.9%；（2）SA占全部检出菌类的25.0%，多药耐药SA为16株，占SA的48.5%；（3）SA感染组溃疡面积大于非SA革兰氏阳性菌感染组及革兰氏阴性菌感染组（P<0.05）；（4）与革兰氏阴性菌感染相比，SA感染组患者多年龄偏大（P<0.01）；骨髓炎发生率较高（P<0.01）；（5）与革兰氏阴性菌感染相比，SA更多分离自感染时间长，溃疡深度较深的患者（P<0.01）；（6）SA对第一、二、三代头孢，喹诺酮类，大环内酯类抗生素均表现出较高耐药率，分别在38.5%~58.8%，37.6%~63.2%，33.4%~62.7%，53.5%~68.9%，30.2%~44.3%之间，发现2例对万古霉素耐药菌株，占6.1%。结论：SA多存在于深部溃疡，且SA引起的感染较重，糖尿病足的SA多药耐药问题较严重，及时进行正确的细菌培养及药敏试验，可以指导合理临床用药及减少耐药菌产生。