Clinical study on methicillin-resistant Staphylococcus aureus infection in patients with diabetic foot

doi:10.3877/cma.j.issn.1674-1358.2020.05.005

Abstract

Abstract:

Objective

To investigate the clinical characteristics of diabetic foot patients with methicillin-resistant Staphylococcus aureus infection.

Methods

Total of 128 patients with diabetic foot complicated with Staphylococcus aureus infection who were admitted to the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture from September 2016 to September 2019 were selected, and the bacteria in the ulcer site of the patients were isolated, cultured and identified, while drug susceptibility was performed. Experiment to analyze the distribution characteristics of pathogens and the drug resistance of Staphylococcus aureus and related influencing factors. Among Staphylococcus aureus isolated from 128 patients, 33 cases were sensitive to methicillin (sensitive bacteria group) and 95 cases were resistant to methicillin (drug-resistant bacteria group).

Results

Total of 128 strains were isolated, including 79 Gram-positive bacteria (61.72%), 45 Gram-negative bacteria (35.16%) and 4 fungi (3.12%). Pathogenic bacteria isolated from patients in the sensitive bacteria group and drug-resistant bacteria group were 33 strains and 95 strains, respectively. The resistance rate of the isolated strains of sensitive bacteria group to rifampicin, ofloxacin, levofloxacin, oxacillin, penicillin G, cefuroxime, azithromycin, cefotaxime and nitrofurantoin were significantly higher than those of drug-resistant bacteria group, with significant differences (χ² = 7.856, 12.309, 19.998, 15.682, 4.072, 30.258, 6.089, 22.233, 5.264, P = 0.004, 0.001, < 0.001, < 0.001, 0.041, < 0.001, 0.007, < 0.001, 0.018). Multivariate Logistic analysis showed that hypoproteinemia, ulcer area, ulcer duration, use of antibiotics 6 months before admission, and hypertension were all infection influencing factors of diabetic foot patients with methicillin-resistant Staphylococcus aureus, all with significant differences (P = 0.001, 0.010, 0.023, 0.012 and 0.029).

Conclusions

Staphylococcus aureus is the main infectious pathogen of diabetic foot disease. Hypoproteinemia, ulcer area, ulcer course, antibacterial use 6 months before admission and hypertension were all infection relevant factors caused diabetic foot patients with methicillin-resistant Staphylococcus aureus.

Key words: Diabetic foot, Staphylococcus aureus, Methicillin, Risk factor

Zhenping Hu, Hui Xu, Mao Ye, Jing. Yu. Clinical study on methicillin-resistant Staphylococcus aureus infection in patients with diabetic foot[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2020, 14(05): 380-385.

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References 28

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组别	例数	男/女（例）	年龄（± s，岁）	体质量（± s，kg/m²）	病程（± s，年）
耐药菌组	33	18/15	67.28 ± 10.11	21.62 ± 2.26	6.72 ± 1.66
敏感菌组	95	53/42	66.69 ± 9.88	22.63 ± 2.31	6.91 ± 1.71
统计量		χ² = 0.113	t = 0.338	t = 0.247	t = 0.503
P值		0.982	0.766	0.898	0.621

组别	例数	男/女（例）	年龄（± s，岁）	体质量（± s，kg/m²）	病程（± s，年）
耐药菌组	33	18/15	67.28 ± 10.11	21.62 ± 2.26	6.72 ± 1.66
敏感菌组	95	53/42	66.69 ± 9.88	22.63 ± 2.31	6.91 ± 1.71
统计量		χ² = 0.113	t = 0.338	t = 0.247	t = 0.503
P值		0.982	0.766	0.898	0.621

病原菌		株数（%）
革兰阳性菌		79（61.72）
	金黄色葡萄球菌	39（30.47）
	链球菌	6（4.69）
	肠球菌	8（6.25）
	凝固酶阴性葡萄球菌	22（17.18）
	类白喉棒状杆菌	4（3.13）
革兰阴性菌		45（35.16）
	克雷伯菌	4（3.13）
	铜绿假单胞菌	18（14.07）
	不动杆菌属	3（2.34）
	芳香黄杆菌	1（0.78）
	柠檬酸杆菌	9（7.03）
	大肠埃希菌	3（2.34）
	变形杆菌	6（4.69）
	嗜水气单胞菌	1（0.78）
真菌		4（3.12）
	假丝酵母菌	4（3.12）
合计		128（100.00）

病原菌		株数（%）
革兰阳性菌		79（61.72）
	金黄色葡萄球菌	39（30.47）
	链球菌	6（4.69）
	肠球菌	8（6.25）
	凝固酶阴性葡萄球菌	22（17.18）
	类白喉棒状杆菌	4（3.13）
革兰阴性菌		45（35.16）
	克雷伯菌	4（3.13）
	铜绿假单胞菌	18（14.07）
	不动杆菌属	3（2.34）
	芳香黄杆菌	1（0.78）
	柠檬酸杆菌	9（7.03）
	大肠埃希菌	3（2.34）
	变形杆菌	6（4.69）
	嗜水气单胞菌	1（0.78）
真菌		4（3.12）
	假丝酵母菌	4（3.12）
合计		128（100.00）

抗菌药物	耐药菌组（33株）	敏感菌组（95株）	χ²值	P值
青霉素G	30（90.91）	66（69.47）	4.072	0.041
苯唑西林	29（87.88）	38（40.00）	15.682	< 0.001
氧氟沙星	19（57.58）	20（21.05）	12.309	0.001
左氧氟沙星	22（66.67）	19（20.00）	19.998	< 0.001
阿奇霉素	29（87.88）	53（55.79）	6.089	0.007
红霉素	27（81.82）	60（63.16）	2.536	0.106
磺胺甲噁唑	9（27.27）	24（25.26）	0.075	0.824
头孢呋辛	23（69.70）	13（13.68）	30.258	< 0.001
头孢噻肟	19（57.58）	11（11.58）	22.233	< 0.001
头孢西丁	27（81.82）	0（0.00）	—	—
万古霉素	0（0.00）	0（0.00）	—	—
利福平	6（18.18）	1（1.05）	7.856	0.004
呋喃妥因	7（21.21）	5（5.26）	5.264	0.018

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