| Objective To investigate the distribution of pathogens,drug resistance characteristics and related factors of mixed infection in patients with diabetic foot ulcer infection,and provide evidence for the selection of clinical anti-infective treatment options.Methods363 patients with diabetic foot ulcer infection who were admitted to the endocrinology department of our hospital from July 2013 to June 2018 were enrolled as diabetic foot ulcer group(DFU group).The clinical and laboratory data were retrospectively analyzed.The number of pathogens in the secretion or tissue culture was further divided into DFU components as a single infection group(n=239)and mixed infection group(n=124).Another 100 non-diabetic patients with chronic skin ulcers were enrolled in our hospital.As a control group,the infection was compared with the distribution of pathogenic bacteria and drug resistance between the DFU group and the control group.Results(1)In the DFU group,the most common type of ulcer was nerve ischemic ulcer(67.22%),and the lowest ischemic ulcer(1.93%);the Wagner's grades of ulcer was the highest in grade 3 and grade 4,accounting for 58.68% and 22.87%.(2)In the DFU group,239 cases(65.84%)had single infection and 124 cases(34.16%)had mixed infection.Among them,the proportion of mixed infection in neuroischemic ulcer was higher than that in neurogenic ulcer(36.07% vs.30.35%),but the differencebetween the two groups was not statistically significant(P>0.05).With the increase of Wagner's grades,the proportion of mixed infection gradually increased(P<0.05),while in single-infected patients,the proportion of Gram-positive bacteria(GPB)infection gradually decreased,and the difference was statistically significant.Academic significance(P<0.05).The proportion of mixed infection in DFU group was significantly higher than that in control group(P<0.01).(3)229 strains of GPB(43.95%),270 strains of gram-negative bacteria(GNB)(51.82%),and 22 strains of fungi(4.23%)were co-cultured in the DFU group.In the control group,34 strains of GPB(27.64%),82 strains of GNB(66.67%)and 7 strains of fungi(5.69%)were cultured.There was no significant difference in the proportion of pathogens between patients with antibiotics in the DFU group and those without antibiotics outside the hospital(P>0.05).In the control group,the proportion of enterococci in patients with antibiotics was higher than that in patients without antibiotics outside the hospital,and the difference was statistically significant(P=0.046).There were differences in the main pathogens between the DFU group and the control group,and the detection rate of GPB in the DFU group was significantly higher than that in the control group(P<0.001).The GNB detection rate was significantly lower than that in the control group(P=0.001).Ischemic ulcer was mainly GPB,which was higher than that of ischemic ulcer,but the difference was not statistically significant(P=0.295).The neuropathic ulcer was mainly GPB,which was significantly higher than that of ischemic ulcer(P<0.001)..Nerve ischemic ulcer was mainly GNB,which was higher than ischemic ulcer,but the difference was not statistically significant(P=0.445).The proportion of GNB in nerve ischemic ulcer was significantly higher than that in neurogenic ulcer.The difference was statistically significant.Significance(P < 0.001).With the increase of Wagner's grades,the proportion of GNB and fungal infections gradually increased,and the proportion of GPB infection gradually decreased.(4)The proportion of mixed infection in the first quarter of the DFU group was lowerthan that in the other three quarters;the GPB infection rate in the four quarters showed a gradual decline.Except for the fourth quarter,the GNB infection rate in the other three quarters gradually increased;the third quarter fungi The infection rate is higher than the other three quarters.The infection pathogens in the control group were mainly GNB,and the proportion in each quarter was higher than that in the DFU group(P<0.01).The proportion of mixed infection in the DFU group was higher than that in the control group(P<0.01).(5)In the DFU group,GPB is more sensitive to vancomycin and linezolid.GNB is more sensitive to ertapenem and amikacin.In the control group,Enterococcus was more sensitive to ampicillin,daptomycin and penicillin;Staphylococcus was more sensitive to linezolid and vancomycin;Escherichia coli to minocycline,compound new Nomin and cefoperazone/sulbactam are more sensitive;Enterobacter is more sensitive to gentamicin,meropenem and piperacillin;proteobacteria,Pseudomonas aeruginosa and Klebsiella to Ami Carstar and ertapenem are more sensitive.(6)There was no significant difference in gender composition,age,duration of diabetes,duration of ulcer,FPG,Hb A1 c,serum creatinine and PLT in the DFU group(P>0.05).Wagner's grades composition ratio existed.The difference(P<0.05),ALB,L%,Hb of patients with mixed infection was lower than that of single infection patients,WBC,N% and CRP were higher than single infection patients(P<0.05).Logistic regression analysis showed that Wagner's grades,ALB,L%,Hb,WBC,N% and CRP were not independent risk factors for mixed infection.Conclusion(1)There are differences in the distribution of pathogenic bacteria,dominant species and infection types of diabetic foot ulcers and non-diabetic skin ulcers;(2)Different admission seasons,different types of ulcers,and severity of ulcers affect the types of bacterial infection in patients with diabetic foot ulcers and non-diabetic skin ulcers;(3)The main pathogens of patients with diabetic foot ulcers and non-diabetic skin ulcers differ greatly in drug sensitivity only by enterococcus,escherichia coli and enterobacter,while staphylococcus,proteus,pseudomonas aeruginosa and cray the difference in primary bacteria is small;(4)Different antibacterial spectrums of different pathogenic bacteria should be paid attention to in clinical treatment.The selection of antibacterial drugs should refer to drug sensitivity results. |
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