Discussion On The Etiology Of Diabetic Foot Ulcer And The Distribution Of Sensitive Antibiotics Based On Yin And Yang Syndrome Differentiation

Objective:To exploring the distribution of infectious pathogens and sensitive antibiotics in diabetic foot ulcer(Diabetic foot ulcer,DFU)patients with different syndromes based on the syndrome differentiation of Yin and Yang in traditional Chinese medicine,to guide the clinical diagnosis and treatment process in the case of no drug susceptibility test results.Good experience in the selection of sensitive antibacterial drugs provides certain guidance value for Chinese and Western medicine in the prevention and treatment of diabetic foot.Methods:Prospectively collect and analyze the relevant data of the patients,select the patients with diabetic foot ulcers admitted to the Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine from January 2020 to March 2021.According to the admission criteria,the patients who meet the criteria are selected,and the general information of the patients is collected.Medical history,main points of TCM syndrome differentiation,etiological culture results and other relevant auxiliary examination data.First,according to the Yin-Yang differentiation method,the TCM syndrome types are unified,and the clinical data of patients belonging to different syndrome types,the pathogenic bacteria detected and the sensitive antibiotics in the drug susceptibility test are compared and analyzed.Result:1.The secretion culture of 70 DFU patients showed that pathogenic bacteria were detected in 68 cases and no bacteria were detected in 2 cases.A total of 84 pathogenic bacteria were detected.Among them,20 strains(23.81%)of multi-drug resistant bacteria were detected;the top 4 strains were Staphylococcus aureus(8 strains),Enterococcus faecalis(7 strains),Escherichia coli(7 strains),Pseudomonas aeruginosa Bacteria(7 strains);32 Gram-positive bacteria(38.09%),52 Gram-negative bacteria(61.90%).The top 3 gram-positive bacteria are Staphylococcus aureu s,Enterococcus faecalis,and Staphylococcus ludens;Enterobacteria are the most common among gram-negative bacteria,and the top 3 are Escherichia coli,Pseudomonas aeruginosa,and the intestine cloacae.Bacillus.The drug sensitivity results showed that among 84 strains of pathogenic bacteria,the top 3 were gentamicin(71 strains),ciprofloxacin(58 strains),and compound trimethoprim(52 strains);of which 32 strains were Gram-positive In the distribution of sensitive antibiotics of pathogenic bacteria,the top 3 are vancomycin(30 strains),linezolid(30 strains),and gentamicin(26 strains);among the sensitive antibiotics of 52 gram-negative pathogens,the top 3 They are Amikacin(Amikacin)(50 strains),Meropenem(46 strains),and Gentamicin(45 strains).There is no significant difference in the types of pathogenic bacteria with different degrees of infection,P<0.05.2.In 70 cases of DFU patients with TCM syndrome differentiation,43 cases of yang syndrome(61.43%),16 cases of half-yin and half-yang syndrome(22.86%),and 11 cases of yin syndrome(15.71%)in the order of TCM differentiation;Comparison of type groups,no performance in general data(sex,age,course of diabetes,etc.),medical history data(type 2 diabetic peripheral vascular disease,type 2 diabetic peripheral neuropathy,hypertension,cardiovascular and cerebrovascular diseases,etc.)There is a statistical difference,P>0.05.In terms of wound-related data,there is no difference in wound location,degree of infection,and wound area among different syndrome groups,P>0.05,but there are differences between groups in terms of infectious pathogens,P<0.05.3.A total of 48 pathogenic bacteria were detected in DFU patients with Yang syndrome based on traditional Chinese medicine,and 2 cases were free of bacteria,including 26 Gram-positive bacteria(54.17%),22 Gram-negative bacteria(45.83%),and the top 4 were Enterococcus faecalis,Staphylococcus aureus,Staphylococcus ludenens and Escherichia coli;22 pathogens were detected in the half-yin and half-yang syndrome,18(81.82%)of gram-negative bacteria were detected,and 4(18.18%)of gram-positive bacteria were detected),the top 3 are Pseudomonas aeruginosa,Klebsiella pneumoniae,Staphylococcus aureus;14 pathogenic bacteria were detected in Yin syndrome,12 gram-negative bacteria(85.71%),gram-positive bacteria 2(14.29%),the top 3 are Enterobacter cloacae,Morganella morganella,and Pseudomonas aeruginosa.Sensitive antibiotics were detected in the Yang syndrome group(48 pathogens),and the top 5 antibiotics were gentamicin(39),ciprofloxacin(31),compound trimethoprim(30),vancomycin(26)),linezolid(26);half-yin and half-yang syndrome group(22 strains of pathogenic bacteria)sensitive antibiotics,the top 5 antibiotics are gentamicin(21),amikacin(amikacin)(18),ciprofloxacin(17),meropenem(16),cefepime(16);yin syndrome group(14 strains of pathogenic bacteria)sensitive antibiotics,the top 5 are meropenem(12),amikacin(Am ikacin)(12),imipenem(11),piperacillin,tazobactam(11)and gentamicin(11).Conclusion:1.The main pathogens of DFU patients are Gram-negative bacteria(61.90%),mainly Escherichia coli,Pseudomonas aeruginosa,Enterobacter cloacae,and amikacin(Amikacin),Meropenem,and gentamicin are highly sensitive;followed by gram-positive cocci(38.09%),mainly Staphylococcus aureus,Enterococcus faecalis,Staphylococcus ludens,against vancomycin,linezolid,gentamicin High sensitivity to mycin;no fungus infection was seen.2.According to TCM syndrome differentiation,Yang syndrome is the most common,followed by half-yin and half-yang syndrome.In Yang syndrome,there are more gram-positive bacteria than gram-negative bacteria,with Enterococcus faecalis,Staphylococcus aureus,Staphylococcus ludens and Escherichia coli Mainly,it is more sensitive to gentamicin,ciprofloxacin,compound trimethoprim,vancomycin,and linezolid;in the half-yin and half-yang syndrome,there are more gram-negative bacteria than gram-positive bacteria,and aeruginosa is false Mainly bacterium,K1 ebsiella pneumoniae,and Staphylococcus aureus,more sensitive to gentamicin,amikacin(amikacin),ciprofloxacin,meropenem,and cefepime There are more gram-negative bacteria than gram-positive bacteria in Yin syndrome,with Enterobacter cloacae,Morganella morganella,and Pseudomonas aeruginosa as the main ones.For meropenem and amikacin(amikacin),Imipenem,piperacillin,tazobactam and gentamicin are more sensitive.3.The syndrome differentiation of TCM has the most Yang syndrome,followed by half-yin and half-yang syndrome.In clinical practice,the empirical antibiotic selection method based on yin and yang differentiation is as follows:Yin-yang syndrome is yang syndrome,priority is given to infections mainly caused by Enterococcus faecalis,Staphylococcus aureus,Staphylococcus ludens and Escherichia coli,and antibiotics are preferred to choose gentamicin,ciprofloxacin,compound trimethoprim,vango Mycin,linezolid.Yin-yang syndrome is a half-yin and half-yang syndrome.Gram-negative bacterial infections are given priority.Pseudomonas aeruginosa,Klebsiella pneumoniae,Staphylococcus aureus are preferred,and gentamicin and amika are preferred as antibiotics.Star(Amikacin),Ciprofloxacin,Meropenem,Cefepime.Yin-yang syndrome is Yin syndrome,and Gram-negative bacteria infection is given priority,mainly Enterobacter cloacae,Morganella morganella,Pseudomonas aeruginosa,antibiotics preferentially choose Meropenem,Amikacin(Amikacin)Su),imipenem,piperacillin,tazobactam and gentamicin.