Clinical Analysis Of Infection And Quality Of Life In Gout Patients With Ulceration Over Tophi

Background:Gout is an inflammatory arthritis resulting from monosodium urate crystals deposition in joints,surrounding tissues and the gradual formation of gouty tophi.With the increasing incidence of gout,ulcer caused by gout stone has become a thorny problem in clinical practice.The skin overlying tophi stone often becomes thinner due to the growth of tophi,and spontaneously breaks or breaks after slight friction,so the tophi on the body surface is more vulnerable to trauma and to produce ulcers.Infection is one of the important factors affecting the prognosis of gout ulcer.Compared with uninfected patients,the healing time of infected patients is significantly prolonged.A few studies have suggested that the ulcer of tophi is susceptible to infection.It is of great significance to further investigate the ulcer infection in patients with tophi ulcerTophi ulcer is not only a serious complication of gout,but also a major cause of disability and poor quality of life in gout patients.When patients with tophi develop ulcers,the appearance,pain,discomfort and obvious disturbance of movement can furtherly cause physical function limitation and significantly increased psychological pressure.The quality of life score of such patients was significantly lower than that of patients with gout without ulcer infection.At present,most research has focused on the management of gout and tophi.However,the literature on the study of tophi ulcer is limited.Therefore,to explore the status of ulcer infection and quality of life in patients with tophi ulcer will help us to deal with this clinical challengeObjective:To analyses etiological characteristics,drug sensitivity and quality of life of patients with gout ulcer could provide reference for better management of gout and prevention and treatment of gout ulcerMethods:The study was divided into the following two parts.The first part selected patients with gout ulcer who were admitted to our hospital from January 2018 to January 2020 as the study object.The patients with diabetic foot ulcer were used as the control group.In the second part,patients with gout ulcer who were admitted to our hospital from January 2019 to January 2020 were selected as the study objects.Gout patients without ulcer and healthy volunteers were used as the control group,and basic data of each group and Short Form-36(SF-36)were collected for comparisonResults:In the first part,we found that the proportion of male patients,the detection rate of gram-positive bacteria(G+)in the gout ulcer group were all higher than those in the diabetic foot ulcer group,while the average age of patients,the infection rate of ulcer,the detection rate of gram-negative bacteria(G-)and the fungal infection rate were all lower than those in the diabetic foot ulcer group(P<0.001).There were differences in the main pathogen species between the two groups,The detection rate of staphylococcus aureus(P=0.035)and pseudomonas aeruginosa(P<0.001)was significantly higher than that of the diabetic foot ulcer group.The top five bacteria in the culture detection rate of gout ulcer were staphylococcus aureus(32.1%),pseudomonas aeruginosa(16.1%),enterococcus faecalis(10.7%),escherichia coli(8.9%)and klebsiella pneumoniae(8.9%).The isolated gram-positive bacteria were all sensitive to linezolid,teicolanine and vancomycin.All the gram-negative bacterial strains isolated were highly sensitive to meropenem with a sensitivity of 100%.the second part,we found that compared with the healthy control group,five domains and the mental component summary(MCS)of SF-36 domains in the gout ulcer free group and the gout stone ulcer group were significantly reduced(P<0.001).Patients presenting with ulcerations over tophi had worse HRQoL scores on three SF-36 domains,the mental component summary(MCS)than gout patients without ulcerations(P<0.05).Conclusions:Compared with patients with diabetic foot ulcer and the detection rate of gram-positive bacteria(G+)were higher in patients with gout ulcer,while the infection rate of ulcer,gram-negative bacteria(G-)and fungal infection rate were lower.Compared with the healthy control group and the patients without ulcer gout,the quality of life of the patients with gout ulcer decreased significantly.