A Preliminary Study On 124 Patients With Diabetic Foot Ulcer Culture And Drug Susceptibility Characteristics Of Different TCM Syndrome Types

Objective:To study the different TCM syndrome types of bacterial infection in patients with diabetic foot ulcer categories and its drug resistance distribution characteristics,to guide the reasonable choice of clinical traditional Chinese and western medicine treatment of antibiotic use.Methods:Statistics the etiology of hospitalized patients with diabetic foot ulcers and other basic information in the first hospital affiliated to Dalian Medical University from February 2002 to November 2016.TCM Syndrome type is carried out in accordance with the relevant guidelines dialectical unity,a retrospective analysis.Results:(1)The TCM syndrome type distribution of 124 patients with diabetic foot ulcer from more to less in the order:Yang deficiency of spleen and kidney,phlegm-stasis in channels>Hyperpyrexic consumption of Yin,obstruction of collaterals>Retention of damp-heat,jin and muscle sores syndrome>Qi and blood deficiency,obstruction of collaterals>Asthenic hepatoyin and nephroyin,blood stasis syndrome.With the exception of Retention of damp-heat,jin and muscle sores syndrome>Hyperpyrexic consumption of Yin,obstruction of collaterals in germiculture positive and Asthenic hepatoyin and nephroyin,blood stasis syndrome>Qi and blood deficiency,obstruction of collaterals in germiculture negative.The rest of the bacteria distribution and overall is the same in different TCM syndrome type basically.(2)The statistical results of secretion from culture in the 124 cases of patients with diabetic foot ulcer as follows:85 cases of positive and 39 cases were negative,a total of 116 strains.Gram positive bacteria has 45 strains(38.97%),giving priority to with staphylococcus epidermidis,streptococcus agalactiae staphylococcus aureus,streptococcus suis,enterococcus faecalis,which have a high susceptibility to nitrofurantoin,linezolid,tecoplanin,cefuroxime,vancomycin.To ciprofloxacin and erythromycin resistant rate is higher,86.67%and 74.19%obviously.54 strains(46.55%)of gram-negative bacteria,with the most common enterobacter(28.45%),such as klebsiella pneumoniae,E.coli,and proteus vulgaris.Other such as pseudomonas aeruginosa,Stenotrophomonas maltophilia,enterobacter cloacae is given priority to,bacterium accounted for 18.10%.Of the imipenem and meropenem highest sensitivity completely without resistance.Amikacin,tobramycin,ertapenem,ticarcillin sensitivity is higher.To ampicillin and cefazolin sodium obvious resistance,sensitive rate were only 9.52%and 9.38%.Fungi,4 kinds of 17 strains,are sensitive to current common antifungal drugs.Specimens of 22 cases of mixed infection,mainly gram-positive and negative bacteria mixed infection or A single gram bacteria infection and part with fungal infection.There is no obvious difference about the drug sensitivity between simple infection and the mixed infection.(3)The distribution about bacteria and drug susceptibility in different TCM syndrome types:Retention of damp-heat,jin and muscle sores syndrome card to gram positive bacteria,accounting.for.59.09%,.mainly staphylococcus epidermidis,staphylococcus aureus,enterococcus faecalis,On the cefuroxime,tecoplanin,vancomycin,nitrofurantoin,Linezolid with high sensitivity.Hyperpyrexic consumption of Yin,obstruction of collaterals have 8 strains(42.11%).Gram-positive cocci to staphylococcus aureus and streptococcus agalactiae could multiplely find,vancomycin,Cefuroxime and nitrofurantoin have high sensitivity.Gram-negative bacillus 6 strains(31.5 8%),giving priority to with klebsiella pneumoniae,and pseudomonas aeruginosa.sensitive antibiotic amikacin and imipenem.This type of comprehensive applicable antibiotics are cefuroxime,imipenem,nitrofurantoi.Qi and blood deficiency,obstruction of collaterals,gram-negative bacillus(56.25%),pseudomonas aeruginosa,e.coli give priority to,and sensitive antibiotic are amikacin,cefuroxime imipenem,meropenem,tobramycin.Gram-positive coccus(7.50%),giving priority to with staphylococcus aureus,staphylococcus epidermidis,sensitive antibiotics is the same as the type 1 gram positive bacteria.Applicable to this type of antibiotics have imipenem and meropenem.Asthenic hepatoyin and nephroyin,blood stasis syndrome,gram-negative bacteria accounted for 64.71%,klebsiella pneumoniae,pseudomonas aeruginosa,stenotrophomonas maltophilia are sensitive antibiotic amikacin,imipenem,ticarcillin.Gram positive cocci(35.29%),giving priority to with staphylococcus epidermidis,staphylococcus aureus,sensitive antibiotics are the same type 1 gram positive bacteria.This type of sensitive antibiotics are cefuroxime,ticarcillin.imipenem and meropenem.Yang deficiency of spleen and kidney,phlegm-stasis in channels,gram-negative bacillus(46.88%),with pseudomonas aeruginosa,enterobacter cloacae,klebsiella pneumonia bacillus with up to see,sensitive antibiotics are cefuroxime,imipenem,meropenem,tobramycin,ticarcillin.Gram positive coccus 12 strains,accounting for 37.50%,giving priority to with enterococcus faecalis,staphylococcus epidermidis,staphylococcus aureus,sensitive antibiotics is the same as the type 1 gram positive bacteria.This type of sensitive antibiotics are cefuroxime,imipenem,meropenem,cefotaxime,tobramycin,ticarcillin.In this study,Retention of damp-heat,jin and muscle sores syndrome and Asthenic hepatoyin and nephroyin,blood stasis syndrome could not find fungi culture positive.The rest 3 types are in fungus culture positive,all fungi to the existing anti-fungal drugs are of sensitivity.Conclusion:(1)the TCM syndrome type distribution seen the most is the Yang deficiency of spleen and kidney,phlegm-stasis in channels in our hospital patients.Probability of the smallest is Asthenic hepatoyin and nephroyin,blood stasis syndrome.(2)The diabetic foot ulcers were cultured positive rate was 68.55%in our hospital.Nearly three years,the cultured positive and negative populations are all increased,mainly gram-negative bacterium,followed by gram-positive bacterium,fungus is relatively rare.Gram-positive bacterium have a high sensitivity to nitrofurantoin,linezolid,tecoplanin,cefuroxime,vancomycin.Gram-negative bacilli are highly sensitive to amikacin and carbapenems,Fungi are widely sensitive to current antifungal drugs.(3)The TCM syndrome types of Retention of damp-heat,jin and muscle sores syndrome is mainly gram-positive bacteria(Such as Staphylococcus epidermidis);Hyperpyrexic consumption of Yin,obstruction of collaterals is often to find gram-positive bacteria(Staphylococcus aureus);Qi and blood deficiency,obstruction of collaterals could find more gram-negative bacteria(Pseudomonas aeruginosa);The Asthenic hepatoyin and nephroyin,blood stasis syndrome to Gram-positive bacteria common(Staphylococcus epidermidis);the Yang deficiency of spleen and kidney,phlegm-stasis in channels is mainly Gram-negative(Pseudomonas aeruginosa,Enterococcus faecalis).Which Retention of damp-heat,jin and muscle sores syndrome and The Asthenic hepatoyin and nephroyin,blood stasis syndrome in the fungal culture negative,The rest of TCM syndrome types in the fungal culture are positive.(4)We should do early secretion of culture and drug sensitive test in the clinical,select the appropriate antibiotics,reduce the generation of drug-resistant bacteria,promote healing of ulcer.Before the outcome of the bacterial culture and drug susceptibility,on the premise of the syndrome types of TCM,suggested that the preferred to gram-negative bacteria sensitive antibiotics,such as carbapenems,amikacin,tobramycin,ticarcillin.