Distribution Of Pathogenic Bacteria And Drug Resistance In Patients With Different Grades Diabetic Foot Infection

Objective:In this study,pathogen culture identification and drug sensitivity test were carried out on tissue specimens of patients with different grades diabetic foot infection to understand the distribution of pathogenic bacteria in patients with different grades diabetic foot infection and to analyze the drug resistance of the major pathogens,and to obtain antibacterial treatment plan for patients with different grades diabetic foot infection in this region,and to provide a reliable basis for clinical empirical anti-infective treatment for diabetic foot.Methods:A total of 92 patients with diabetic foot infection who were admitted to our hospital from June 2017 to September 2018 were enrolled.According to the Wagner classification of diabetic foot and the severity of diabetic foot,they were divided into Wagner1,Wagner2,Wagner3,Wagner4 and Wagner5.And Wagner grade 1 and Wagner grade 2 diabetic foot infection patients were defined as mild infection group;Wagner grade 3 diabetic foot infection patients were moderate infection group;Wagner grade 4 and Wagner grade 5 diabetic foot infection patients were severe infection group.Among the 92 patients,there were 43 cases in mild infection group,24 cases in the moderate infection group and 25 cases in the severe infection group.When the patient first treated the wound,the tissue at the edge of the deep lesion of the patient was collected as a specimen,and the pathogen culture identification and drug sensitivity test were carried out to analyze the distribution of pathogens and the drug resistance of the main pathogens in patients with different grades diabetic foot infection.The distribution of pathogens and drug resistance in this experimental results were statistically analyzed using WHONET5.5 software.The remaining statistical indicators were statistically analyzed using SPSS22.0 software.The comparison of count data was performed by X~2 test.The difference was statistically significant at P<0.05.Results:1 Distribution of pathogenic bacteria in patients with different grades diabetic foot infection.In this study,a total of 92 tissue specimens from patients with diabetic foot infection were collected.One of the specimens was negative,and the other specimens were positive.A total of 115 pathogens were cultured,and 20specimens were mixed infection.In the mild infection group,43 specimens were sent for examination,and 1 specimen was negative for culture,and the remaining specimens produced 49 strains of pathogens,including 36Gram-positive bacteria(73.5%)and 12 Gram-negative bacteria(24.5%),1strain of fungi(2.0%).Gram-positive bacteria causing mild infection are mainly Staphylococcus aureus,accounting for 58.33%of the total number of Gram-positive bacteria in this group.6 cases of mild infection group were mixed infection.In the moderate infection group,24 specimens were sent and32 strains of pathogens were cultured,including 12 Gram-positive bacteria(37.5%),Gram-negative bacteria 19(59.4%),and 1 fungus(3.1%).The Gram-negative bacteria causing moderate infection were mainly Escherichia coli,Pseudomonas aeruginosa and Serratia liquefaciens,which accounted for36.84%,15.79%and 10.53%of the total number of Gram-negative bacteria in this group,respectively.5 cases of moderate infection group were sent for mixed infection.In the severe infection group,25 specimens were sent and a total of 34 pathogenic bacteria were cultured,including 12 Gram-positive bacteria(35.3%),21 Gram-negative bacteria(61.8%),and 1 fungus(2.9%).The Gram-negative bacteria causing severe infection were mainly Enterobacter cloacae,Acinetobacter baumannii and Citrobacter freundii,accounting for 23.81%,19.05%and 14.29%of the total number of Gram-negative bacteria in this group,respectively.9 cases of severe infection group were mixed infection.Statistical analysis showed that there were differences in the distribution of Gram-positive and Gram-negative bacteria in patients with different grades diabetic foot infection,and the difference was statistically significant(X~2=15.543,P<0.05).2 Analysis of drug resistance in patients with different grades diabetic foot infectionThe main pathogen of the mild infection group was Staphylococcus aureus and the sensitivity of drug sensitivity test to vancomycin,linezolid,gentamicin and minocycline was 100%,100%,90.48%and 90.48%,respectively.10 strains of multi-drug resistant bacteria in the mild infection group,accounting for 20.41%of the total number of pathogens in this group.The main pathogens of the moderate infection group were Escherichia coli,Pseudomonas aeruginosa and Serratia liquefaciens and the sensitivity of drug sensitivity test to imipenem,amikacin and cefepime was 100%,90%and81.81%,respectively.There were 8 strains of multi-drug resistant bacteria in the moderate infection group,accounting for about 25%of the total number of pathogens in this group.The main pathogens of severe infection group were Enterobacter cloacae,Acinetobacter baumannii and Citrobacter freundii and the sensitivity of drug sensitivity test to imipenem and amikacin was 91.67%and 80.00%,respectively.There were 13 strains of multi-drug resistant bacteria in the severe infection group,accounting for 38.24%of the total number of pathogens in the group.Conclusion:1 There are differences in the distribution of Gram-positive and Gram-negative bacteria in different grades diabetic foot infection.The mild infection was mainly Gram-positive bacteria infection.The moderate infection was mainly Gram-negative bacteria infection.The severe infection was mainly Gram-negative bacteria infection.And with the deepening of the degree of infection in diabetic foot,the proportion of patients with mixed infection was gradually increasing.2 The main pathogenic bacteria in the mild infection was sensitive to vancomycin,linezolid,gentamicin and minocycline.The main pathogens in the moderate infection was sensitive to imipenem,amikacin and cefepime.The main pathogenic bacteria in the severe infection was sensitive to to imipenem and amikacin.And with the deepening of the degree of diabetic foot infection,the proportion of multi-drug resistant bacteria is gradually increasing,and the resistance of most antibiotics is gradually increasing.3 In the first visit of diabetic foot patients,according to the severity of the diabetic foot infection,clinical features and the main pathogens and drug resistance of different grades of diabetic foot infection in the local region,the doctor can empirically select the corresponding antibacterial drugs for treatment.Severely infected patients can choose combined medication,and if necessary,combined with other treatments,such as surgical treatment.