Distribution And Antibiotic Susceptibility Of Pathogens Isolated From Patients With Recurrent Diabetic Foot Infection

Objective: The diabetic foot infection (DFI) is hard to be controlled with thereason of high level blood glucose, deficiency of immune function, and the increasedadhesion of pathogens to mucosal or epithelial cells. The amputation rate is increasedbecause of recurrent DFI which make people realize that effective controlling of DFIis helpful to decrease amputation, improve the prognosis and reduce family and socialfinancial burden. The present study recruited90DFI patients from2012/01to2014/01, observing the composition and types of the pathogens, analyzing theantibiotic resistance of the main pathogens in order to get the rule of pathogenspectrum development, preliminarily discussing the relative risk factors for DFI,which can provide guidance for preventing and treating DFI in clinic.Method:90patients in our hospital from2012January to2014January indiabetic foot infection patients were recruited according to the inclusion criteria.Ankle brachial index(ABI)were measured for all the patients, wound secretionspecimens were cultured for bacterial analysis and antibiotic test, andthe data werestatistically analyzed.Results:25cases were infected for the first time, accounting for the total numberof27.8%.65patients had a history of diabetic foot infection, accounting for the totalnumber of72.2%. The severity levels of diabetes foot were from Ⅱ to Ⅴ in Wagner’sgrading method, including22patients in levelⅡ,accounting for24.4%of thetotalnumber,27patients in level Ⅲ, accounting for30.0%of the total number,35patientsin levelⅣ, accountingfor38.9%of the total number,6patients in level Ⅴ, accountingfor6.7%of the total number.32strains of pathogenic bacteria were cultured in the25patients with initialDFI,including20strains of gram positive bacteria, accounting for62.5%of the totalnumber, mainly being Staphylococcus aureus (8stains), Enterococcus faecalis (9strains) and Streptococcus (3strains);9strains of gram negative bacteria accountingfor28%of the totalnumber, mainly being Escherichia coli (2strains), Pseudomonasaeruginosa (2strains), Klebsiellapneumonia (3strains) and Proteus (2strains).140strains of pathogenic bacteria were cultured in65patients with recurrent DFI, including66strains of gram positive bacteria, accounting for47.1%of the totalnumber, mainly being Staphylococcus aureus (31strains), Enterococcus faecalis (20strains)and Streptococcus (5strains).55strains of gram negative bacteriaaccountingfor39.3%of the total number, mainly being Escherichia coli (21strains),Pseudomonas aeruginosa (11strains), Klebsiellapneumonia (9strains) and Proteus (8strains).The results of antibiotic susceptibility test showed that: the gram positive cocciwas severely resistant to penicillin, but was sensitive to ceftriaxone, vancomycin, withno resistance tovancomycin; the gram negative bacteria had serious resistance tocefalexin, cefotaxime, erythromycin, but was sensitive to Panipenemwith lowerresistance.17patients with initial DFI showedmulti drug resistance (68%).14initial DFIpatients had peripheral vascular disease (PVD) with the prevalence rate at56%.62patients with recurrent DFI showed multi drug resistance (95.4%). Throughstatistical analysis, multi drug resistance of bacteria was found to be significantlycorrelated to the recurrence of DFI (p<0.05).56patients with recurrent DFI showed PVD with the prevalence rate at86.2%.Through statistical analysis,PVD was found to be significantly correlated to therecurrence of DFI (p<0.05).Conclusions: The species of pathogens causing DFIs are various, and havecertain drug resistance to ordinary antibiotics which should be used in a rational way.It should be aware that DFI patients with multidrug resistant pathogens and peripheralvascular disease may be more easily infected again.