Analysis Of Pathogen Distribution And Antibiotic Sensitivity In Patients With Diabetic Foot Ulcer

Objective:Diabetic foot ulcer(DFU)is one of the common complications of diabetes mellitus.This disease affects the activity of patients and brings a lot of inconvenience to the daily life of patients.During the treatment of the disease,most of the time patients have to stay in bed and they must be accompanied by nursing staff.This treatment occupy a large number of valuable medical resources.If patients with DFU is accompanied by infection,it will significantly increase the time of treatment.The risk of amputation is significantly increased.So it is important to determine whether DFUs are accompanied by infection,what pathogens may cause the infection,and what antibiotics the pathogen is sensitive to.Based on the situation above,appropriate drugs should be used for treatment to avoid catastrophic consequences such as amputation.Therefore,understanding the characteristics and clinical outcome of patients with DFU in Changchun area and exploring the prevalence and drug sensitivity of foot pathogens may provide scientific evidence for clinicians to use antibiotics empirically in the course of treatment.Methods:According to the criteria defined in the 2017 diabetic foot diagnostic guidelines,78 patients with DFU are selected from the Second Hospital of Jilin University hospital from August 2016 to February 2019.The demographic data,general laboratory results,clinical outcomes,general bacterial culture and drug sensitivity test results are collected retrospectively,and the severity of the disease is classified according to Wagner standard.The EXCEL table is used to input the data and the database is established.Then the statistical analysis was carried out by SPSS software.Results:The patients with DFU are mainly male aged 50-70 years old.The most common site of ulcer is toes.Laboratory test showed that there was a tendency of anemia and low albumin.In addition,79.4%(62/78)of all patients with DFU treated in our hospital were classified as Wagner 3 or above.In this study,78 samples of DFU secretions were included for general bacterial culture and drug sensitivity test.The results shows that 72 samples were positive for pathogenic bacteria.The positive rate was 92.3%,of which 52 samples are infected by single pathogen(72.2%)and 20 samples are infected by mixed bacteria(27.8%).A total of 33 strains(42.3%)of Gram-positive bacteria and 45 strains(57.7%)of Gram-negative bacteria are isolated from 72 samples.Among the Gram-positive bacteria,18 strains(23.1%)are Staphylococcus aureus,followed by Streptococcus lactis(6.4%)and Enterococcus faecalis(2.5%).Among the Gram-negative bacteria,the main positive bacteria were Escherichia coli(21.8%),Pseudomonas aeruginosa(6.4%)and Klebsiella pneumoniae(5.1%).According to the Wagner classification,as the severity of the disease aggravate,the infection pathogens tend to increase in Gram-negative bacteria infection and mixed infection.The most sensitive drugs against Gram-positive bacteria are ampicillin,ampicillin / sulbactam,quinupudine-Damiflu,rifampicin,linezolid,gentamicin,cefepime,ceftriaxone and levofloxacin and the drugs with the highest resistance rate are clindamycin,erythromycin,penicillin G,compound xinnomin.The most sensitive drugs against Gram-negative bacteria are amikacin,meropenem,imipenem and cefotetane and the drugs with the highest resistance rate are cefazolin,ampicillin,cefuroxime axetil,cefuroxime sodium and compound neomycin.Conclusion:1.DFU patients features in our hospital: mainly middle-aged and elderly male groups,and the most common ulcer site is the toe.The condition is relatively serious when the patient is treated,and the overall nutritional status is poor.2.Gram-negative bacterial infections were the most common in DFU patients in our hospital,but Staphylococcus aureus infection by single pathogen was the most common pathogen.3.For mild cases with suspected gram-positive bacterial infection,the recommended drugs are ampicillin,ampicillin/sulbactam,cefepime,ceftriaxone and levofloxacin and the drugs not recommended are clindamycin,erythromycin,penicillin G.For severe cases with suspected gram-negative bacterial infection,the recommended drugs are amikacin,meropenem,imipenem and cefotetan and the drugs not recommended are cefazolin,ampicillin,cefuroxime ester and cefuroxime sodium.