Bacterial Spectrum And Antibiotic Application Analysis Of Diabetes Foot Infection

Objective:To analyze the pathogenic characteristics of diabetes foot infection(DFI)and the changes in the sensitivity and resistance of the main pathogens to commonly used antibiotics,so as to provide reference for the selection of clinical DFI antibacterial treatment programs.Methods:From January 2012 to December 2020,the bacterial culture results of 680 patients with DFI from the Provincial Hospital Affiliated to Shandong First Medical University were collected and analyzed,to explore the characteristics of the pathogenic bacteria of DFI and the changes in the sensitivity and resistance of the main infectious bacteria to commonly used antibacterial drugs.Results:1.In the total study population,single pathogen infections(529 cases,77.8%)and G(281 cases,53.1%)were the main causes of DFI;In mixed infections,G+and G-(73 cases,48.3%)were the main mixed infections;The infection rate of fungi(12 cases,2.3%)has increased;The infection rates of MDR strains,especially MRSA and ESBL,are on the rise.Among the top three pathogens,G+was Staphylococcus aureus(191 cases,59.1%),Enterococcus faecalis(57 cases,17.6%),Streptococcus agalactiae(17 cases,5.3%),G-was Pseudomonas aeruginosa(79 cases,18.8%),Escherichia coli(78 cases,18.6%),Enterobacteriaceae cloacae(53 cases,12.6%).2.In DFI with different Texas grades,as the depth of ulcer increases,the infection rate of Gram positive bacteria decreased,and there was a statistical difference among the G1,G2,and G3 groups(p<0.001);The infection rate of Gram negative bacteria increased,reaching statistical significance among the three groups(p=0.045);Staphylococcus aureus showed a downward trend,with statistical differences among the three groups(p<0.001);Enterococcus faecalis showed an upward trend,and there was a statistical difference among the three groups(p<0.001).3.In DFI with different Texas stages,the non-ischemic group was mainly infected with G+,while the ischemic group was mainly infected with G-;Compared with the non-ischemic group,the infection rate of Gram positive bacteria in the ischemic group decreased,and the difference was statistically significant(p<0.001);The infection rate of Gram negative bacteria increased,and the difference reached statistical significance(p<0.001);Mixed infection increased,with G-mixed infection being the main cause,and the difference reached statistical significance(p=0.037);The detection rate of Staphylococcus aureus decreased,with a statistically significant difference(p=0.001);The detection rate of Enterococcus faecalis increased,with a statistically significant difference(p<0.001).4.In the DFI of the pre 2018 and post 2018 groups,compared with the pre 2018 group,the post 2018 group showed a decrease in mixed infection,and the difference between the two groups reached statistical significance(p=0.020);Post 2018 Group,the infection rate of βStreptococcus hemolyticus decreased,with a statistically significant difference(p=0.046);The infection rate of Streptococcus agalactiae increased,with a statistically significant difference(p=0.003);Post 2018 Group,the infection rate of drug-resistant bacteria increased,and the difference reached statistical significance(p=0.004);Post 2018 Group,the MRSA infection rate increased,with a statistically significant difference(p=0.002);Post 2018 Group,the ESBL infection rate increased,with a statistically significant difference(p=0.007).5.In DFI,Staphylococcus aureus is generally sensitive to moxifloxacin and vancomycin,and resistant to penicillin G,ceftriaxone and ampicillin.Pseudomonas aeruginosa is generally sensitive to amikacin,cefepime,levofloxacin,and meropenem,and resistant to amoxicillin clavulanic acid potassium,ceftriaxone,and clindamycin.As the depth of the ulcer increased in different Texas grades,the sensitivity of Pseudomonas aeruginosa to cefepime in the G1,G2,and G3 groups was 61.5%,100%,and 65.3%,respectively,with an increasing trend and statistical difference(p=0.026).In different Texas stages,Pseudomonas aeruginosa in ischemic group was newly resistant to amoxicillin clavulanic acid potassium and clindamycin.The sensitivity of Staphylococcus aureus to moxifloxacin in the group after 2018 was 73.7%lower than that in the group before 2018(88.8%),with a statistically significant difference(p=0.01 2);Post 2018 Group,Pseudomonas aeruginosa added resistance to clindamycin.Conclusion:1.DFI pathogens are mainly G-,mostly single pathogen infections;In mixed infections,G+and G-mixed infections are the main ones;The fungal infection rate has increased;The infection rate of MDR strains,especially MRSA and ESBL,is on the rise.2.Different Texas grades,with the increase of ulcer depth,the infection rate of Gram positive bacteria decreases,the infection rate of Gram negative bacteria increases,the detection rate of Staphylococcus aureus decreases,and the detection rate of Enterococcus faecalis increases.3.In different Texas stages,compared with the non-ischemic group,the ischemic group showed a decrease in the infection rate of Gram positive bacteria,an increase in the infection rate of Gram negative bacteria,and an increase in mixed infections,with G-mixed infections being the main type;The detection rate of Staphylococcus aureus decreases,while the detection rate of Enterococcus faecalis increases.4.The DFI of the pre 2018 and post 2018 groups,compared to the pre 2018 group,the post 2018 group showed a decrease in mixed infections,The infection rate of β Streptococcus hemolyticus decreased,the infection rate of Streptococcus agalactiae increased,and the infection rate of drug-resistant bacteria(including MRSA,ESBL)increased.5.In DFI,Staphylococcus aureus is generally sensitive to moxifloxacin and vancomycin,and resistant to penicillin G,ceftriaxone,and ampicillin.Pseudomonas aeruginosa is generally sensitive to amikacin,cefepime,levofloxacin,and meropenem,and resistant to amoxicillin clavulanic acid potassium,ceftriaxone,and clindamycin.Different Texas grades,as the depth of the ulcer increases,the sensitivity of Pseudomonas aeruginosa to cefepime increased.In different Texas stages,Pseudomonas aeruginosa in ischemic group was newly resistant to amoxicillin clavulanic acid potassium and clindamycin.With time migration,the sensitivity of Staphylococcus aureus to moxifloxacin decreased;Post 2018 Group,Pseudomonas aeruginosa added resistance to clindamycin.