| Objective:To review the drug resistance characteristics of MDR and clinical characteristics of infected patients and TCM Syndrome Types in DFU infection,which is helpful to clarify the composition and drug resistance of drug-resistant bacteria in the Department,to understand the current situation of multi drug-resistant bacteria infection,to understand and prevent the infection of DFU,to protect the susceptible patients,to formulate the corresponding prevention strategies and antibiotics use strategies,It can provide some guidance value for the prevention and treatment of DFU multi drug-resistant bacteria infection in Chinese and Western medicine.Methods:This study was a retrospective analysis of medical records.55 patients with MDR infection were selected from the admission diagnosis of TCM surgery,the Second Affiliated Hospital of Tianjin University of traditional Chinese medicine from January 1,2016 to December 31,2019.55 patients with DFU infection were selected as the study group,and 55 patients with same sex and age were selected as control group,First,the clinical data and ulcer of patients with MDR infection were analyzed statistically.Then the clinical characteristics and laboratory indexes of the two groups were compared by the comparative analysis of the two groups.The multivariate logistic regression analysis was carried out to explore the risk factors of the infection and establish the risk prediction model.result:1.35 men with multiple drug resistance bacteria infection in DFU accounted for 63.6%;The female cases were 20,accounting for 36.4%;Age range of 55 patients 67.02±10.42,among them,the number of 66-75 years old cases was the most,19 cases,accounting for 34.5%;The average number of inpatients in 55 patients was 16.4±4.04 days;There were 20 cases of smoking history,accounting for 36.4%;12 cases had drinking history,accounting for 21.8%;14 cases had a history of DFU ulcer,accounting for 25.5%;49 cases had antibiotic exposure history,accounting for 89.1%;37 cases had a history of hospitalization within one year,accounting for 67.3%;47 cases had a history of debridement before the hospitalization,accounting for 85.5%;The history of previous interventional therapy was 7 cases,accounting for 12.7%;19 cases of toe cutting history accounted for 34.5%;The number of patients with diabetes mellitus was the most in 5-10 years,15 cases,accounting for 27.3%.The ulcer burst time was 4 cases within 1 week,accounting for 7.3%;6 cases were found in 1 week to 2 weeks,accounting for 10.9%;15 cases were found in 2 weeks to 1 month,accounting for 27.3%;From January to February,6 cases were found,accounting for 10.9%;From February to March,9 cases were found,accounting for 16.4%;There were 2 cases in March April,accounting for 3.6%;There was one case from April to may,accounting for 1.8%;There were 4 cases in May June,accounting for 7.3%;There were 8 cases over June,accounting for 14.5%;There were 34 patients without obvious inducement,accounting for 61.8%;6 patients broke after repairing their feet,accounting for 10.9%;One patient suffered from tinea pedis,accounting for 1.8%;8 patients were injured and broken by operation,accounting for 14.5%;4 patients found the rupture after scald of feet,accounting for 7.3%;2 patients were broken by walking shoes,accounting for 3.6%;There were 15 patients with Wagner grade 2,accounting for 27.3%;Wagner grade 3 was found in 12 patients,accounting for 21.8%;Wagner grade 4 was found in 28 patients,accounting for 50.9%;There were 14 patients with pedis infection grade 1,accounting for 25.5%;The infection grade of pidis was 2,accounting for 47.3%;The infection grade of pedis was 3,accounting for 15%;32 patients had 1 ulcer,accounting for 58.2%;There were 2 ulcers in 11 patients,accounting for 20%;There were 3 ulcers in 6 patients,accounting for 10.9%;There were 4 ulcers in 2 patients,accounting for 3.6%;There were 5 ulcers in 3 patients,accounting for 5.5%;One patient had 6 ulcers,accounting for 1.8%;38 patients with neuro ischemic ulcer(69.1%).The gray values of the left dorsal and toe areas were the lowest,among which the gray values of the fifth toe and the plantar toe joint were the lowest.2.39 patients with gram-negative MDR were found in DFU,accounting for 65%,of which 16 cases were detected,accounting for 41%;9 cases were Klebsiella pneumoniae,accounting for 23.1%;8 cases were Pseudomonas aeruginosa,accounting for 20.5%;There were 3 cases of abnormal strain,accounting for 7.7%;One case was Klebsiella acidogenesis,accounting for 2.6%;One case was morningeria,accounting for 2.6%;One case was preveniensis,accounting for 2.6%.21 cases were infected with gram-positive multidrug-resistant bacteria,accounting for 35%,of which 18 cases were Staphylococcus aureus,accounting for 90.5%;One case was Staphylococcus hemolysis,accounting for 4.8%;One case was Staphylococcus epidermidis,accounting for 4.8%.3.in this study,7 cases of cold and wet obstruction of collaterals were found in DFU patients with multiple drug-resistant bacteria infection,accounting for 12.7%,age 68.71±12.18 years old;There were 7 cases of blood stasis syndrome,accounting for 12.7%,age 65.00±8.72 years old;One case of Yin Syndrome with heat and poison injury accounted for 1.8%,aged 61 years old;The age of the patients with damp heat and toxin was 14,accounting for 25.5%,and the age was 64.14±7.82 years old;26 cases of Qi Yin deficiency syndrome accounted for 47.3%,age 68.88±11.72 years old.4.Univariate analysis showed that there were significant differences between the two groups in antibiotic exposure history,hospitalization history within one year,Qi and yin deficiency syndrome,hypertension,osteomyelitis,anemia,Wagner grade,neuro ischemic ulcer,white blood cell count,hemoglobin,red blood cell count,hematocrit,creatinine,urea nitrogen,thrombin time,activated partial thromboplastin time,blood pressure,blood pressure,blood pressure,etc Fibrinogen,anion gap,triglyceride,procalcitonin,troponin y-There were statistically significant differences in glutamyl transpeptidase and total bilirubin(P<0.05),but there were significant differences in gender,age,length of hospital stay,smoking history,drinking history,diabetes history,ulcer history,debridement history before admission,vascular interventional therapy history,toe amputation history,TCM syndrome type,diabetic nephropathy,diabetic retinopathy,coronary heart disease,cerebrovascular disease,ulcer time,diabetes mellitus,diabetes Predisposing factors,pedis infection grade,number of ulcers,percentage of neutrophils,percentage of lymphocytes,percentage of monocytes,percentage of eosinophils,percentage of basophils,neutrophil count,lymphocyte count,platelet,mean platelet volume,red blood cell distribution width SD,glucose enzyme method,glycosylated hemoglobin,uric acid Prothrombin time,carbon dioxide binding capacity,potassium,sodium,chlorine,total cholesterol,high density lipoprotein,low density lipoprotein,C-reactive protein,myoglobin,CK-MB mass α-There were no significant differences in hydroxybutyrate dehydrogenase,creatine kinase,lactate dehydrogenase,creatine kinase isoenzyme,globulin,albumin ratio,aspartate aminotransferase,alanine aminotransferase,direct bilirubin,total protein,albumin and alkaline phosphatase(P>0.05).5.the data of two groups showed that the single factor analysis showed that the data with statistical significance were analyzed by binary logistic regression.The results showed that antibiotic exposure history,hospitalization history within one year,combination and concurrent hypertension,osteomyelitis,Qi Yin deficiency and other factors were the risk factors of multiple drug-resistant bacteria infection in DFU patients,which was statistically significant(P<0.05).The logistic model of MDR infection in DFU patients was established as follows:logit(P)=6.191+(-2.712)*antibiotic exposure history+(-1.400)*hospitalization history within one year+(-1.281)*hypertension+(-3.605)*osteomyelitis+(-1.686)*Qi Yin deficiency syndrome.The ROC curve evaluation model was drawn.AUC=0.900,95 CL value:0.843-0.957,the maximum cutoff point was 0.70,and the sensitivity was 0.782 and the specificity was 0.87.The calibration of the model was tested.The hosme Leme show test was used to test the model fitting degree was 67.75,P<0.001.Conclusion:1.in this study,the patients with MDR infection were more male than female,and the elderly were more likely to develop.Most patients had no obvious cause of breaking.Wagner4,pedis infection grade 2,neuro ischemic ulcer were the main causes,and the ulcer was mainly in the left foot back and toe,among which the best was left fifth toe and metatarsophalangeal joint.2.the results showed that the infection of gram-negative multidrug-resistant bacteria(65%)was more than that of gram-positive ones(35%).The main strains of gram-negative multidrug-resistant bacteria are multiple resistance Escherichia coli,Klebsiella pneumoniae and Pseudomonas aeruginosa.The most important strain of gram-positive multidrug-resistant bacteria is Staphylococcus aureus.Gram negative multidrug resistance bacteria are generally resistant to ampicillin,cefazolin,cefuroxime sodium,cefuroxime,cefuroxime,and are generally sensitive to buconamycin,doripenem,astapenem,meropenem,piperacillin/tazobactam.Gram positive multidrug resistance bacteria are generally resistant to benzoxacillin,penicillin G and erythromycin,and are more sensitive to ciprofloxacin,gentamicin and moxifloxacin,and are not resistant to furantoin,linazolidine,quinoloptine/daprotin,rifampin,tegasellin and vancomycin.3.in this study,the TCM syndrome type of DFU multiple drug resistant bacteria was Qi Yin deficiency syndrome(47.3%),followed by damp heat toxin(25.5%),and the age of patients with Qi Yin deficiency syndrome was the largest,68.88±The duration of diabetes was the longest in 11.72 years old.30.8%of the patients had diabetes course in 20-30 years,followed by 10-20 years(19.2%)and 5-10 years(19.2%).4.multivariate logistic regression analysis showed that the factors such as antibiotic exposure history,hospitalization history within one year,history of hypertension,osteomyelitis,deficiency of Qi and Yin were independent risk factors for multiple drug-resistant bacterial infection. |
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