Distribution And Drug Resistance Of Pathogenic Bacteria In Diabetic Foot Infection

Background and Objective:Diabetic foot ulcer(DFU)is a common complication of diabetes.The foot ulcer infection(DFI)can cause disability or even death of diabetes patients,and seriously damage the health and quality of life of diabetes patients.It is of great significance to understand the distribution and drug resistance of pathogenic bacteria in DFI patients for clinical rational anti-infection treatment.Previous studies have shown that there are differences in the distribution and drug resistance of pathogenic bacteria in DFI patients in different regions,different times,different hospitals and different degrees of illness.The infectious bacterial spectrum and drug resistance of DFI showed a changing trend.In this study,the distribution and drug resistance of pathogenic bacteria in DFI patients in Weihai Maternal and Child Health Care Hospital were analyzed,aims to provide references for DFI treatment in our hospital.Methods:A total of 200 patients with diabetic foot ulcers in our hospital were included in this study from January 2016 to December 2018.Bacteria culture,pathogen identification and drug sensitivity test were conducted in all patients before antibiotic treatment.The incidence of DFI and the distribution of DFI pathogens were analyzed in DFI patients with different Wagner grades,ulcer areas and and ulcer types.The drug resistance of the pathogen was tested.Results:(1)The detection rate of DFI was 90.00%(180/200).A total of 215pathogenic bacteria were cultured,including 120(55.81%)strains of Gram-positive(G~+)bacteria,76(35.35%)strains of Gram-negative(G~-)bacteria and 19(8.84%)strains of fungi(all Candida albicans).There were 67 strains with mixed infection among 32patients,among which G~+and G~-mixed infections were the main types.The most common G~+bacteria were Staphylococcus aureus,Streptococcus agalactiae and Staphylococcus hemolyticus,while the most common G~-bacteria were Escherichia Coli,Pseudomonas aeruginosa and Klebsiella pneumoniae.The distribution of G~+bacteria and G~-bacteria in DFI patients among different years was not significantly different.(2)The distributions of G~+bacteria and G~-bacteria in DFI patients among different Wagner grades,ulcer areas and ulcer types were all significantly different(χ~2=15.575～44.556,P<0.001).The detection rate of G~+bacteria in patients with Wagner grade IV+V(13.64%,3/22)was significantly lower than that of I+II+III group(67.24%,117/174)(χ~2=23.640,P<0.001).The detection rate of G~+bacteria(41.74%,48/115)in ischemic and neuro-ischemic DFI was significantly lower than that of neurological DFI(88.89%,72/81)(χ~2=44.504,P<0.001).The detection rate of G~+bacteria in DFI patients with large-area ulcers(48.04%,49/102)was significantly lower than that of small ulcers(75.53%,71/94)(χ~2=15.575,P<0.001).(3)The incidence of drug resistance was 63.72%(137/215),of which 93 strains of pathogenic bacteria were multi-drug resistant,and the incidence of multi-drug resistance was 43.26%.Staphylococcus aureus was the most multi-drug resistant bacteria(39/89).Methicillin resistant Staphylococcus aureus accounted for 16.13%(10/62)of Staphylococcus aureus,and Ultra broad spectrumβ-Extended spectrum beta lactamases(ESBLs)accounted for 41.03%(16/39)of the total number of Escherichia coli and Klebsiella pneumonia.Conclusions:(1)The pathogens of DFI patients in the present study are mainly G~+bacteria,followed by G~-bacteria,with a small amount of fungi.(2)The infection rate of G~+bacteria decreases as the increase of Wagner grade,ulcer area and ischemic/neuro-ischemic ulcers in DFI patients,while the infection rate of G~-bacteria increases.(3)Due to high drug resistance rate of DFI pathogenic bacteria,pathogenic identification and drug sensitivity test for DFI patients should be carried out timely for selecting appropriate antibiotics.