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中华实验和临床感染病杂志(电子版) ›› 2018, Vol. 12 ›› Issue (01) : 65 -70. doi: 10.3877/cma.j.issn.1674-1358.2018.01.013

所属专题： 文献；

临床论著

糖尿病合并不同临床表型肺部感染者的细菌谱分析
刘春妮1, 初卫江2, 高爱芹1, 饶小胖1,†()   
  1. 1. 266109　青岛市，山东省青岛市城阳区人民医院
    2. 261400　莱州市，山东省莱州市第三人民医院内分泌科
  • 收稿日期:2017-02-18 出版日期:2018-02-15
  • 通信作者: 饶小胖

Bacterial analysis of pulmonary infection in patients with diabetes mellitus complicated with different clinical phenotypes

Chunni Liu1, Weijiang Chu2, Aiqin Gao1, Xiaopang Rao1,†()   

  1. 1. People’s Hospital of Qingdao Chengyang District, 266109 Qingdao, China
    2. Department of Endocrinology, The Third People’s Hospital of Laizhou, 261400 Laizhou, China
  • Received:2017-02-18 Published:2018-02-15
  • Corresponding author: Xiaopang Rao
  • About author:
    Corresponding author: Rao Xiaopang, Email:
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引用本文：

刘春妮, 初卫江, 高爱芹, 饶小胖. 糖尿病合并不同临床表型肺部感染者的细菌谱分析[J]. 中华实验和临床感染病杂志(电子版), 2018, 12(01): 65-70.

Chunni Liu, Weijiang Chu, Aiqin Gao, Xiaopang Rao. Bacterial analysis of pulmonary infection in patients with diabetes mellitus complicated with different clinical phenotypes[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2018, 12(01): 65-70.

目的

探讨糖尿病合并不同临床表现肺部感染者的细菌分布情况，有针对性地制定抗感染对策。

方法

根据208例糖尿病合并肺部感染者的不同临床表现分为呼吸道症状组（RS）、全身症状组（SS）及综合症状组（CS）共3组，取其痰分泌物进行病原学培养，培养菌株232株，统计学分析采用SPSS软件。

结果

CS组混合感染（19.13%）较RS组（4.00%）和SS组患者（11.39%）显著上升（χ2= 5.41，P=0.01）；RS组患者革兰阳性球菌（G+C）感染仅占20%，SS组患者G+C感染占69.6%，CS组患者G+C感染为33.9%（χ2= 9.90，P=0.001）；RS组患者革兰阴性杆菌（G－B）感染占76%，SS组患者G－B感染仅占25.3%，CS组患者G－B感染为59.3%（χ2= 14.87，P=0.001）；RS组患者葡萄球菌对莫西沙星、阿奇霉素、克林霉素、庆大霉素、左氧氟沙星、环丙沙星、四环素、青霉素、利福平、头孢呋辛和头孢唑肟耐药率显著低于SS组和CS组（P均< 0.05）。SS组患者链球菌对莫西沙星、阿奇霉素、克林霉素、四环素、头孢呋辛及头孢唑肟耐药率显著低于CS组（P均< 0.05）；SS组患者ECO对莫西沙星、庆大霉素及头孢唑肟耐药率显著低于CS组（P均< 0.05）；RS组患者肺炎克雷伯菌对亚胺培南、头孢哌酮舒巴坦、哌拉西林他唑巴坦、头孢吡肟、头孢噻汚、头孢他啶、头孢唑肟、庆大霉素、环丙沙星、左氧氟沙星、氨曲南和氨苄西林耐药率显著低于SS组和CS组患者（P均< 0.05）；RS组患者中铜绿假单胞杆菌和鲍曼/溶血不动杆菌对头孢哌酮舒巴坦、哌拉西林他唑巴坦、头孢吡肟、头孢噻汚、头孢他啶、头孢唑肟、庆大霉素、环丙沙星、左氧氟沙星、氨曲南及氨苄西林耐药率显著低于SS组和CS组患者（P均< 0.05）。

结论

糖尿病合并不同临床表型肺部感染患者的细菌谱分布存在差异；针对以上感染特点有助于指导临床进行抗感染治疗。

关键词: 糖尿病, 临床表型, 肺部感染, 细菌谱
Objective

To investigate the pathogenic conditions of pulmonary infection in patients with diabetes.

Methods

Total of 208 patients with diabetes complicated with pulmonary infection of different clinical manifestations were divided into three groups: respiratory symptoms group (RS group), systemic symptom group (SS group) and comprehensive syndrome group (CS group), and the pathogen of their sputum were cultured for 232 strains, and the statistical analysis was carried out by SPSS 16.0 software.

Results

Mixed infection (19.13%) in CS group was significantly higher than those of the RS group (4.00%) and the group SS (11.39%). In patients of the RS group, the infection rate of Gram positivecocci(G+C) was 20%, which were 69.6% in the SS group and 33.9% in the CS group, with significant difference (χ2= 9.90,P= 0.001). G-B infection rate of patients of the RS group was 76%, which were 25.3% in the SS group and 59.3% in the CS group, with significant difference (χ2 = 14.87,P= 0.001). The resistance rates ofStaphylococcusto moxifloxacin, azithromycin, clindamycin, gentamicin, erythromycin, levofloxacin, ciprofloxacin, tetracycline, penicillin, rifampicin, cefuroxime and ceftizoxime of the RS group were significantly lower than those of SS group and CS group (allP< 0.05). The resistance rates ofStreptococcusto azithromycin, moxifloxacin, clindamycin, erythromycin, tetracycline, cefuroxime and ceftizoxime in the SS group were significantly lower than those of the CS group (allP< 0.05). The resistance rates ofEnterococcusto moxifloxacin, gentamicin and ceftizoxime in patients of the SS group were significantly lower than those of in the CS group (allP< 0.05). In patients of the RS group, the resistance rates ofKlebsiella pneumoniato imipenem, cefoperazone, cefoperazone sulbatam, piperacillin tazobactam, cefotaxime, cefotaxime, ceftazidime, ceftizoxime, gentamicin, ciprofloxacin, levofloxacin, aztreonam and ampicillin were significantly lower than those of the SS group and CS group (allP< 0.05). In patients of the RS group, the resistance rates ofPseudomonas aeruginosaandAcinetobacterto cefoperazone sulbatam, piperacillin tazobactam, cefotaxime, cefotaxime, ceftazidime, ceftizoxime, gentamicin, ciprofloxacin, levofloxacin, aztreonam and ampicillin were significantly lower than those of SS group and CS group (allP< 0.05).

Conclusions

The bacterial spectrum distribution of patients with diabetes combined with pulmonary infection of different clinical phenotypes were different. In view of the above infection characteristics, it is helpful to guide clinical antiinfection treatment.

Key words: Diabetes, Pulmonary infection, Clinical phenotype, Bacterial spectrum
表1 各组糖尿病合并肺部感染的菌谱特点（%）
组别 例数 菌株 细菌培养率 G+菌 G－菌 真菌 混合感染
RS组 55 50 95.00 20.00 76.00 4.00 4.00
SS组 70 79 100.00 69.60 25.30 5.10 11.39
CS组 83 103 100.00 33.90 59.30 6.80 19.41
χ2值 0.57 9.90 14.87 0.02 5.41
P值 0.09 0.001 0.001 0.60 0.01
表2 病原菌检测结果
病原菌 RS组 SS组 CS组
菌株 构成比（%） 菌株 构成比（%） 菌株 构成比（%）
G+球菌
肺炎链球菌 15 30.00 12 15.00 11 10.60
金黄色葡萄球菌 0 0.00 13 16.50 12 11.70
表皮葡萄球菌 0 0.00 10 12.70 4 3.90
草绿色链球菌 0 0.00 7 8.90 2 1.90
肠球菌 0 0.00 4 5.00 4 3.90
其他球菌 0 0.00 9 11.50 2 1.90
G－杆菌
肺炎克雷伯菌 18 36.00 8 10.10 32 31.00
铜绿假单胞杆菌 5 10.00 5 6.30 12 11.70
奇异变形杆菌 4 8.00 3 3.80 6 5.90
鲍曼/溶血不动杆菌 2 4.00 2 2.50 5 4.90
弗氏柠檬酸杆菌 2 4.00 1 1.30 3 2.90
不动杆菌 2 4.00 1 1.30 3 2.90
真菌
白色念珠菌 2 4.00 3 3.80 5 4.90
光滑球拟酵母菌 0 0.00 1 1.30 2 1.90
合计 50 100.00 79 100.00 103 100.00
表3 G+球菌耐药率（%）
抗菌药物 链球菌 葡萄球菌 肠球菌
RS（n = 15） SS（n = 19） CS（n = 15） χ2值 P值 RS（n = 0） SS（n = 23） CS（n = 16） χ2值 P值 RS（n = 0） SS（n = 4） CS（n = 4） χ2值 P值
庆大霉素 25.00 78.42 80.23 53.02 0.001 — 80.00 82.14 0.89 0.690 — 50.00 83.33 35.29 0.001
莫西沙星 1.22 7.23 6.24 4.42 0.040 — 20.00 16.34 4.34 0.040 — 28.00 45.00 15.24 0.002
万古霉素 0.00 0.00 0.00 0.65 0.810 — 0.00 0.00 1.06 0.460 — 0.00 0.00 0.63 0.180
利奈唑胺 0.00 0.00 0.00 0.96 0.760 — 0.00 0.00 2.01 0.330 — 0.00 0.00 0.52 0.210
左氧氟沙星 20.00 50.00 82.00 46.10 0.001 — 68.31 71.38 0.74 0.080 — 100.00 100.00 0.54 0.260
环丙沙星 16.00 56.00 65.00 15.86 0.001 — 70.10 70.89 0.82 0.130 — 100.00 100.00 0.59 0.300
克林霉素 25.00 52.00 73.00 4.30 0.030 — 48.85 53.09 5.88 0.040 — 98.32 100.00 0.68 0.070
四环素 50.00 48.00 79.00 10.91 0.010 — 75.76 100.00 9.89 0.010 — 100.00 100.00 0.62 0.430
阿奇霉素 14.00 42.00 58.00 28.87 0.001 — 50.91 72.78 9.65 0.010 — 100.00 85.00 6.25 0.010
利福平 78.65 89.80 92.30 9.35 0.002 — 100.00 100.00 0.90 0.240 — 100.00 100.00 0.58 0.480
青霉素 78.00 96.00 100.00 10.68 0.010 — 98.00 100.00 0.48 0.090 — 100.00 100.00 0.49 0.160
头孢呋辛 14.00 28.15 33.65 6.16 0.035 — 42.36 46.59 4.25 0.040 — 100.00 94.44 2.21 0.058
头孢唑肟 24.00 33.33 42.44 9.31 0.012 — 40.00 53.24 8.45 0.010 — 85.54 100 9.24 0.001
表4 G－杆菌的耐药率（%）
抗菌药物 肺炎克雷伯菌 铜绿假单胞杆菌和鲍曼/溶血不动杆菌
RS（n = 18） SS（n = 8） CS（n = 32） χ2值 P值 RS（n = 9） SS（n = 8） CS（n = 20） χ2值 P值
哌拉西林他唑巴坦 0.00 8.00 12.22 4.85 0.020 0.00 10.10 25.00 26.32 0.001
头孢他啶 3.89 20.00 33.33 53.74 0.001 2.24 25.00 42.16 37.09 0.001
头孢噻无 2.21 18.22 38.20 38.24 0.001 5.62 42.35 58.94 40.50 0.001
头孢哌酮舒巴坦 0.00 10.11 16.44 6.06 0.030 0.00 14.00 20.39 11.65 0.002
头孢吡肟 0.00 3.45 6.89 5.94 0.002 0.00 8.82 12.43 4.31 0.030
庆大霉素 25.00 52.86 68.00 7.47 0.001 20.00 50.00 68.00 9.42 0.003
亚胺培南 0.00 1.23 2.09 0.78 0.120 0.00 0.00 0.00 0.05 0.130
左氧氟沙星 50.00 75.00 90.00 23.90 0.003 75.00 92.86 100.00 8.60 0.010
环丙沙星 48.50 62.37 73.55 15.82 0.015 25.00 85.88 95.00 45.90 0.001
氨苄西林 58.00 76.88 82.89 19.04 0.001 75.00 92.33 100.00 14.26 0.001
头孢唑肟 12.50 61.55 72.43 25.14 0.001 15.70 57.85 66.90 33.50 0.001
氨曲南 37.50 52.63 57.14 9.88 0.022 25.00 63.97 85.71 24.81 0.001
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