Distribution Of Bacterial Infection And Drug Sensitivity In Diabetic Foot Patients With Different Wagner Grades In Affiliated Hospital Of Yan’an University

Objective:To investigate the distribution of bacterial infection and drug resistance of diabetic foot patients with different Wagner grades in Affiliated Hospital of Yan’an University,and to provide guidance for clinicians to use antibiotics reasonably.Materials and methods:A retrospective analysis of basic information(gender,age,duration of diabetes,and complications of diabetes)in 206 diabetic foot patients admitted to the Yan’an University Affiliated Hospital from February 2011 to December 2019,and related clinical and biochemical indicators[White blood cell count(WBC),neutrophil percentage(NEU#),fasting blood glucose(FBG),glycated hemoglobin(HbA1c),triglycerides(TG),total cholesterol(TC),Low-density lipoprotein cholesterol(LDL-C),High-density lipoprotein cholesterol(HDL-C),uric acid(UA),C-reactive protein(CRP),Procalcitonin(PCT),Erythrocyte sedimentation rate(ESR),Fibrinogen(FIB)],None Bacteria were collected from diabetic foot ulcer specimens,and microbiological identification was performed using our hospital’s fully-automated pathogen identification system.Based on the results of the culture of diabetic foot secretions and antibiotic sensitivity and resistance reported by the laboratory,patients were classified according to the results of the detected bacteria.Gram-positive bacteria(G~+bacteria),Gram-negative bacteria(G~-bacteria),and fungi were used to analyze diabetic foot infections with different Wagner classification by statistical methods.Clinical data between those isolated pathogens and antibiotic susceptible and resistant characteristics.Results:1.Among the 206 patients,83 were positive,the positive rate was 40.29%,and the total number of pathogens was 24.Among them,54(65.06%)were infected by G+bacteria,26(31.33%)by G-bacteria and 3(3.61%)by fungi.Staphylococcus aureus(26 cases,48.15%)and Staphylococcus epidermidis(9 cases,16.67%)were the main G+bacteria.Escherichia coli(7 cases,26.92%)and Proteus vulgaris(5 cases,19.23%)were the main G-bacteria.2.Compare the general clinical data of G~+bacteria and G~-bacteria in our hospital,from gender,age,course of disease,WBC,NEU#,HbA1c,TC,TG,HDL-C,LDL-C,ESR,FIB and whether it is combined with diabetic retinopathy,diabetic nephropathy and other variables Statistical analysis found that there was no statistical difference between the two groups of variables(P>0.05),while CRP and PCT were statistically significant between the two groups of variables(P<0.05).3.The clinical data collected from diabetic patients were divided into infection group(80 cases)and uninfected group(123 cases)according to whether they were infected or not,except for 3 cases of fungal infection.Infection group and uninfected group were statistically analyzed for inflammation factors The WBC,NEU,CRP,PCT,FIB,and ESR of the patients in the group were increased compared with the uninfected group,and the infection degree increased with the increase of Wagner classification.(P<0.05).4.Staphylococcus aureus has the highest resistance rate to erythromycin and green forest mold,both being 92.31%,while the resistance rates to penicillin and tetracycline are76.92%and 69.23%,respectively.The resistance rate of staphylococcus epidermidis to erythromycin is 100.0%,and the resistance rates to chloroformin,penicillin,and tetracycline were 77.78%,77.78%,and 66.67%.Staphylococcus aureus was 100.0%sensitive to vancomycin,while Staphylococcus epidermidis was 88.89%sensitive to vancomycin.In addition,Staphylococcus aureus is also more sensitive to linezolid,rifampicin,levofloxacin,compound sinomine,furantan,gentamicin,and ciprofloxacin,respectively:96.15%and96.15%,92.31%,88.46%,84.62%,80.77%,80.77%,and Staphylococcus epidermidis has a higher sensitivity rate to antibiotics such as rifampicin,linezolid,levofloxacin,and gentamicin,which are 100.0%and 88.89%,respectively.,66.67%,66.67%.Escherichia coli is completely resistant to ciprofloxacin,and the resistance rates to gentamicin,ampicillin,and aztreonam are 71.43%,71.43%,and 42.86%,respectively.Proteus common to Meropenem,Cefepime,tobramycin,and cefazolin are completely insensitive,while the resistance rates to the compound sirolimus,gentamicin,and ampicillin are 40.0%,40.0%,and 20.0%,respectively.Escherichia coli is as sensitive as 100.0%to meropenem,cefepime,and compound sirolimide,while it is 57.14 to susceptor,aztreonam,ceftriaxone sodium,amoxicillin,and amikacin.%,71.43%,57.14%,42.86%,85.71%.Proteus common is completely sensitive to aztreonam and ciprofloxacin,while the sensitivity rates to ceftriaxone sodium,fadaxin,cefotetan,compound sinomine,and imithiomycin are 40.0%,40.0%,40.0%,60.0%,80.0%.In addition,Candida albicans was 100.0%resistant to itraconazole and fluconazole,and 100.0%sensitive to miconazole and econazole.Conclusion:1.The patients with diabetic foot ulcer infection in our hospital are mainly G~+bacteria,followed by G~-bacteria,with less fungi,and no mixed infection bacteria have been cultured;2.When the Wagner classification is≤2,the infection is mainly G~+bacteria.As the Wagner classification increases,the infection worsens,and the isolated bacteria spectrum gradually changes from G~+bacteria to G~-bacteria,and the bacteria species are gradually enriched.3.G~+bacteria are mainly sensitive to antibiotics such as vancomycin,rifampicin,levofloxacin,and gentamicin,and resistant to erythromycin,chloroformin,penicillin,and tetracycline;G~-bacteria are mainly resistant to aztreonam and compound Neonomine is sensitive and resistant to gentamicin and ampicillin.