Analysis Of Distribution Characteristics Of Pathogens And Changes Of Antibiotic Resistance In Diabetic Foot Infection

ObjectivesTo investigate the distribution characteristics of DFI pathogens and the changes in antibiotic resistance in our hospital in the past 10 years,and to provide a theoretical basis for the empirical anti-infection of DFI in this area.Method348 DFI hospitalized patients in the past 10 years were selected as the research objects.Their general clinical data,laboratory data,microbial culture results and antibiotic resistance results were collected.Result1.DFI patients in our hospital were more common in elderly men(>60 year old)and Wagner grade 2 chronic ulcers.Microbial culture suggests that there were more Gram-positive bacteria than Gram-negative bacteria,and fungal infection couldn’t be ignored.The most common Gram-positive bacteria was Staphylococcus aureus,the most common Gram-negative bacteria was Pseudomonas aeruginosa,and the most common fungus was Candida albicans.Gram-positive bacteria dominated in mild infections,single infections,and acute ulcers.Gram-negative bacteria dominated in severe infections,mixed infections,and chronic ulcers.There are differences in the levels of platelets,total cholesterol,and low-density lipoprotein cholesterol in different kinds of pathogens.2.Analysis of drug susceptibility results of Gram-positive bacteria indicated that Staphylococcus were highly resistant to penicillin in the past 10 years,and the resistance rate of erythromycin was also high,while Staphylococcus were relatively sensitive to moxifloxacin,rifampicin,nitrofurantoin,quinupristin/dalfopristin,and 100%sensitive to vancomycin,linezolid,tigecycline,and teicoplanin.Enterococcus were highly resistant to tetracycline,erythromycin,quinupristin/dalfopristin,and highly sensitive to penicillin and nitrofurantoin,while they were 100%sensitive to vancomycin,teicoplanin,and tigecycline.Streptococcus were highly resistant to erythromycin,clindamycin and tetracycline,while they were highly sensitive to moxifloxacin,ciprofloxacin,levofloxacin,and 100%sensitive to ampicillin,nitrofurantoin,quinupristine/dalfopristin,vancomycin,teicoplanin,linezolid,tigecycline.Among the above three Gram-positive bacteria genera,there was no statistical difference in the changes in drug resistance between 2011～2015 and 2016～2020.3.Analysis of drug susceptibility results of Gram-negative bacteria suggested that Enterobacteriaceae were highly resistant to ampicillin in the past 10 years,and the resistance rates of cefazolin,cefuroxime and nitrofurantoin were relatively high.What’s more,the drug resistance rate of cefazolin in 2016～2020 increased significantly compared with 2011～2015.Enterobacteriaceae was highly sensitive to piperacillin tazobactam,cefoperazone sulbactam,tobramycin,amikacin,ertapenem,imipenem,and 100%sensitive to meropenem.Pseudomonas was highly resistant to ampicillin,cefazolin,ceftriaxone,cefoxitin,amoxicillin and clavulanic acid,compound trimethoprim,nitrofurantoin,and tigecycline in the past 10 years.The drug resistance rate of ciprofloxacin and imipenem in 2016～2020 increased significantly compared with 2011～2015,and Pseudomonas was sensitive to piperacillin,cefepime,piperacillin,tazobactam,and amikacin.4.In the past 10 years,some fungi were resistant to itraconazole.The most of fungi were sensitive to flucytosine,voriconazole,fluconazole,and amphotericin B.Conclusion1.DFI patients in our hospital were more common in elderly men(>60 year old)and Wagner grade 2 chronic ulcers.Gram-positive bacteria were the main ones,and Staphylococcus aureus was the most abundant.Gram-positive bacteria dominated in mild infections,single infections,and acute ulcers.Gram-negative bacteria dominated in severe infections,mixed infections,and chronic ulcers.The distribution of platelets,total cholesterol,and low-density lipoprotein cholesterol in Gram-positive bacteria,Gram-negative bacteria,and fungi were different.2.Except the natural insensitive antibiotics of pathogens,erythromycin should be avoided in DFI patients if Staphylococcus infection was suspected;Quinupristin/Dafopristin should be avoided in Enterococcus;Tetracycline should be avoided in Streptococcus;In the past 10 years,the drug resistance of the above three Gram-positive bacterial genera was relatively stable.Cefuroxime should be avoided in Enterobacteriaceae;And the resistance rate of Enterobacteriaceae to cefazolin in the 2016～2020 increased significantly compared with 2011-2015.What’s more,the resistance rate of Pseudomonas to ciprofloxacin and imipenem increased significantly in 2016～2020 compared with 2011～2015;Therefore,we should pay attention to monitoring the resistance of Pseudomonas to ciprofloxacin and imipenem.Last but not least,the monitoring of antifungal drug should be strengthened.