Distribution Of Pathogenic Bacteria,Characteristics Of Bacterial Resistance And Cost Of Antimicrobial Treatment Of Diabetic Foot Infection With Different Wagner Grades

Purpose:Analyze the relationship between the distribution of pathogens,drug resistance and the cost of antibiotic treatment in diabetic foot infection(DFI)based on different Wagner grades.Methods:A retrospective survey of 216 hospitalized patients with diabetic foot ulcers admitted in First Affiliated Hospital of Chongqing Medical University from January 2014 to January 2016 was conducted to analyze the distribution of pathogenic bacteria,bacterial resistance and multidrug resistant bacteria in the specimens of foot ulcers,and the cost of antibiotic treatment in hospitalized patients with DFI patients in different Wagner grades.Results:263 strains of pathogenic bacteria were isolated from the specimens of 216 patients with DFI,of which 57.4%were single bacteria,42.6%were mixed bacteria,mainly Staphylococcus aureus,Enterococcus,Enterobacter aeruginosa and Pseudomonas aeruginosa.Gram-positive(G~+)bacteria Gram-negative(G~-)bacteria and fungi accounted for 43.5%,48.1%and 8.4%respectively With the aggravation of Wagner classification based on the severity of infection,the detection rate of Staphylococcus aureus in the G~+strain decreased gradually,while the Enterobacteriaceae in the G~-strain increased gradually.There is no statistically significant difference in the distribution of gram-postive bacteria and gram-negative bacteria in different Wagner grades(P=0.526).Gram-postive bacteria are susceptible to vancomycin,linezolid,moxi-floxacin and tigecyclin,more than 75%.Gram-negative bacteria are susceptible to carbapenems,amikacin,compound preparation of anti pseudomonas penicillin,four generation of cephalosporins and cephamycins,more than 64%.73 strains of bacteria containing MDR are isolated,mainly Staphylococcus aureus,Proteus mirabilis,Escherichia coli,and Klebsiella pneumoniae.Taking the cost of Wagner2 grade foot infection as the baseline,the statistical analysis showed that the total hospitalization cost,antimicrobial treatment cost and proportion of total hospitalization expenses of the patients with Wagner grade 3 or 4 were significantly increased,and there was significant statistical difference.Compared with 173 cases of non-multidrug resistant bacteria infection,the statistical analysis showed that the total hospitalization cost,antimicrobial treatment cost and proportion of total hospitalization expenses increased significantly in 43 cases of multidrug-resistant bacteria infection,and there were significant statistical differences.53 cases of non MDR mixed bacteria infection were significantly higher than those with single bacteria infection(26 cases of G~+bacteria infection,27 cases of G~-bacteria infection and 6 cases of fungi infection)in total hospitalization costs and antimicrobial treatment costs,with significant statistical differences.Conclusion:The pathogenic bacteria composition of diabetic foot ulcer is related to Wagner grade.In general,single bacterial infection were slightly more than mixed bacterial infection,G~-bacteria were slightly superior to G~+bacteria infection distribution,and G~+and G~-bacteria to commonly used anti-G~+bacteria and G~-bacteria drugs have a better sensitivity,but MDR bacteria were close to 30%of the isolated bacteria.The total hospitalization expenses and the cost of antibacterial treatment were related to the Wagner classification and the drug resistance of the pathogenic bacteria.With the increase of the grade and the infection of MDR bacteria,the total hospitalization expenses,the cost of antibacterial treatment and proportion of total hospitalization expenses were significantly increased and there were significant statistical differences.