老年糖尿病足溃疡患者多重耐药菌危险因素分析

Analysis of risk factors for multidrug-resistant organism infection in elderly patients with diabetic foot ulcers

中文关键词: 老年  糖尿病足溃疡  多重耐药菌感染  危险因素

英文关键词: elderly  diabetic foot ulcer  multidrug-resistant organism infection  risk factor

中文摘要:

      目的 分析老年糖尿病足溃疡(DFU)患者多重耐药菌(MDRO)的危险因素.方法 回顾性选取2020年1月—2023年1月青岛市胶州中心医院收治的168例分泌物病原学检测为阳性的老年DFU患者的临床资料,根据病原学检测结果将其分为MDRO组(n=62)和非MDRO组(n=106).分析MDRO组感染情况,比较2组患者的临床资料,采用Logistic回归方法分析影响DFU患者MDRO感染的危险因素.结果 62例MDRO患者共分离病原菌69株,其中以革兰阴性菌中大肠埃希菌(28.99％)最为多见.MDRO组患者糖化血红蛋白(HbA1c)＜7％、糖尿病病程≥15年、Wag-ner分级4～5级、入院前有抗菌药物史、合并骨髓炎、抗菌药物疗程＞7 d,血糖水平标准差(SDBG)均高于非MDRO组,空腹C肽水平低于非MDRO组,差异均有统计学意义(P＜0.05).Logistic回归显示,糖尿病病程≥15年、入院前有抗菌药物史、合并骨髓炎、抗菌药物疗程＞7 d均为影响DFU患者MDRO感染的危险因素(P＜0.05).结论 老年DFU患者MDRO感染以革兰阴性菌大肠埃希菌最为常见.临床应重点关注糖尿病病程≥15年、入院前有抗菌药物史、合并骨髓炎、抗菌药物疗程＞7 d的老年DFU患者.

英文摘要:

      Objective To analyze the risk factors for multidrug-resistant organism(MDRO)infection in elderly pa-tients with diabetic foot ulcers(DFU).Methods The clinical data of 168 elderly DFU patients with positive pathogen detec-tion of secretions admitted to Jiaozhou Central Hospital of Qingdao City from January 2020 to January 2023 were retrospectively selected.According to the results of etiological detection,patients were divided into MDRO group(n=62)and non-MDRO group(n=106).The infection situation in the MDRO group was analyzed.The clinical data were compared between the two groups.Logistic regression was used to identify risk factors for MDRO infection in DFU patients.Results A total of 69 patho-genic strains were isolated from the 62 MDRO patients.Escherichia coli(28.99％)were the most common among Gram-nega-tive bacteria.The proportions of HbA1c＜7％,course of diabetes mellitus ≥ 15 years,Wagner grades 4-5,use of antibiotics before admission,comorbid osteomyelitis and course of antibiotics＞7 d,and standard deviation of blood glucose(SDBG)lev-el in the MDRO group were higher than those in the non-MDRO group,while fasting C-peptide level was lower than that in the non-MDRO group(P＜0.05).Logistic regression analysis showed that course of diabetes mellitus ≥ 15 years,history of anti-biotic use before admission,comorbid osteomyelitis,and antibiotic course＞7 days were all risk factors for MDRO infection in DFU patients(P＜0.05).Conclusion MDRO infections in elderly DFU patients are most commonly caused by Gram-nega-tive Escherichia coli.Clinical attention should be focused on elderly DFU patients with course of diabetes mellitus ≥ 15 years,use of antibiotics before admission,comorbid osteomyelitis,and antibiotic course＞7 days.