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

doi:10.3877/cma.j.issn.1674-1358.2018.01.013

Abstract

Abstract:

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

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.

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References 28

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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

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

病原菌		RS组		SS组		CS组
病原菌		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

病原菌		RS组		SS组		CS组
病原菌		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

抗菌药物	链球菌					葡萄球菌					肠球菌
抗菌药物	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

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