Analysis Of Pathogenic Bacteria Changes And Related Factors Of Diabetic Foot Infection

Objective:To retrospectively analyze the characteristics,drug resistance and related factors of pathogenic bacteria in patients with diabetic foot infection(DFI).Methods:Patients with diabetic foot(DF)hospitalized in our hospital from 2014 to 2018 were enrolled.The clinical characteristics,laboratory examination,foot secretion culture,blood culture and drug sensitivity were retrospectively collected.The distribution characteristics of pathogenic bacteria,drug sensitivity results and related factors of the patients were analyzed.Results:Among the 574 patients with DF,698 strains of pathogenic bacteria were isolated in 484 patients,including Gram-negative bacteria 348(49.9%),Gram-positive bacteria 342(49%),and fungus 8(1.1%).The top three pathogens were Staphylococcus aureus(23.8%),Escherichia coli(7.7%),Enterobacter cloacae(7.2%).There were 331 single infections and 153 mixed infections(≥2 kinds of bacteria).In the past five years,the detection number of pathogenic bacteria showed an overall upward trend,which were 95,117,128,197 and 161 strains,respectively.The positive and negative bacteria ratios were:(37:58),(59:55),(59:68),(95:100),(92:67).In the first 4 years,the total number of bacteria,gram-positive bacteria and gram-negative bacteria increased year by year and reached a peak in 2017.In 2018,the increase of gram-positive bacteria tended to be flat,while the gram-negative bacteria show a downward trend.From 2014 to 2018,the detection rate of methicillin-resistant staphylococcus(MRS)was higher,which was 34.5%,34.1%,44.7%,50.8%,48.3%,respectively.The total detection rate of MRSA in 5 years was 38.6%,31.6%,34.6%,43.3%,41.7% and 37.2%,respectively.Gram-negative bacteria were the main pathogens in Wagner3~5 grade DFI patients,while gram-positive bacteria were the main pathogens in Wagner 1~2 grade DFI patients.The fungal infections are Candida albicans and Candida tropicalis,which are highly sensitive to fungal drugs with a sensitivity rate of 100%.The most common Gram-negative bacteria are Escherichia coli,which is highly sensitive to meropenem,imipenem,piperacillin,tazobactam and cefotetan with a sensitivity rate of > 90%,and resistant to cefoperazone,cefuroxime,levofloxacin and moxifloxacin with a sensitivity rate of < 60%.The most common Gram-positive bacteria are Staphylococcus aureus,which is highly sensitive to quinolones(both >80%),of which ciprofloxacin(81.3%),levofloxacin(86.1%),and moxifloxacin(91.5%).It is the most sensitive to vancomycin,linezolid and tigecycline(>97%),and highly resistant to benzylpenicillin,clindamycin and erythromycin.Multivariate logistic regression analysis showed that long duration of diabetic foot disease,peripheral vascular disease,peripheral neuropathy,high white blood cells,high glycosylated hemoglobin,and low density lipoprotein were the main risk factors for DFI.Conclusion:This study showed that from 2014 to 2018,the number,species and drug-resistant strains of DFI pathogenic bacteria were on the rise,and the change of pathogenic bacteria in DFI patients in our hospital was as follows: the proportion of gram-positive bacteria was on the decline,and gram-negative bacteria was on the rise.The pathogens of moderate to severe DFI patients(Wagner level 3~5 grade)were mainly gram-negative bacteria,mainly Escherichia coli,Enterobacter cloacae and Klebsiella pneumoniae.The drug sensitivity test was sensitive to piperacillin,tazobactam,ceftazidime,meropenem,imipenem,cefepime and amikacin.The pathogens of mild to moderate DFI patients(Wagner 1~2 grade)were mainly gram-positive bacteria,mainly Staphylococcus aureus,and were sensitive to vancomycin,linezolid,tigaricycline and quinolone antibiotics.For DFI patients,sensitive antibiotics should be selected according to Wagner grading experience,and then adjusted according to drug sensitivity results.