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论 著 糖尿病足感染葡萄球菌属临床及耐药特点分析丁群, 李代清, 冯书红, 王鹏华, 褚月 颉, 孟树优, 孙茜( 天津医科大学代谢病医院卫生部及天津市激素与发育重点实验室, 天津 300070)摘要: 目 的 分析糖尿病足感染(DFI) 创面分离的葡萄球菌属临床及耐药特点。 方法 2008 年1 月 - 2009 年 12月 从医院 277 例 DFI 溃疡中分离出 84 株金黄色葡萄球菌( SAU) 及 48 株表皮葡 萄球菌(SEP) , 总结 132 例患者临床特点, 分析耐药菌与下肢血液循环及溃疡深度( Wagner 分级) 间 的关系 ; 采用 K-B 纸 片扩散法进行药敏试验, 分析细菌耐药特点。 结果 耐甲氧西林金黄色葡萄球菌( MRSA) 及甲氧西林敏感金黄色葡萄球菌(M SSA) 、耐甲氧西林表皮葡萄球菌( MRSE) 及甲氧西林敏感表皮葡 萄球菌( MSSE) 中分离 自 缺血性和Wagner3、4 级溃疡的菌株所占比例均高于单纯 神经性和 Wagner1、 2 级溃疡; 与 MSSA 相 比, MRSA 更多分离自 Wagner3、4 级溃疡, 差异有统计学意义(P< 0. 05) ; SAU、SEP 中多药耐药菌分别占 60. 7% 和 72. 9% , MRSA、MRSE 分别占 SAU与 SEP 的 27. 4% 、 33. 3% , 均为 多 药耐药菌; M RSA、 MRSE 对 -内酰胺类、 大环 内 酯 类耐药率均 > 75. 0% ;MRSE 对磺胺甲噁唑/ 甲氧苄啶耐药率( 81. 3% ) 比 MRSA(34. 8% ) 高, 差异有统计学 意义 ( P< 0. 01) ; MSSA、MSSE 对青霉素 G、大环内酯类耐药率均> 60. 0% ; 未发现耐万古霉素菌株。 结论 耐药葡萄球菌属多 见于合并深部溃疡和下肢血运差的患者, DFI 中葡萄球菌属多药耐药问 题较严重, 及时进行正 确的细 菌培养及药敏检测,可以指导临床合理用药以减少耐药菌的产生及播散。关键词: 糖尿病足感染; 耐甲氧西林金黄色葡萄球菌; 耐甲氧西林表皮葡萄球菌中图分类号: R378. 1+1 文献标识码: A文章编号: 1005 -4529(2011) 03-0481 -03Clinical features and drug resistance of staphylococci causingdiabetic foot infectionsDING Q un, LI Da- i qing, FENG Shu -hong, WANG Peng -hua,CHU Yue -jie, MENG Shu -you, SUN Qian(Key Lab of Hormones and Dev elop ment, Ministry of Health , Metabolic Diseases H ospital,Tianj in Medical Univ ersity , Tianj in 300070, China)Abstract: OBJECTIVE T o investigate clinical features and antibiotic resistance of St aphylococci isolated frompatients with diabetic foot infections (DFI) in T ianjin Metabolic Diseases Hospit al. METHODS Totally 84 S. au-reus ( SAU) and 48 S. epidermidis (SEP) strains w ere isolated from 277 diabetic foot ulcers in the hospital fromJan 2008 to Dec 2009. The clinical features of 132 patients w ere summarized. T he relat ionships betw een t heisolates and the ischemic/ simple neuropathic ulcers, and the Wagner grades w ere analyzed. The disk - diffusionmethod was performed to examine ant imicrobial susceptibility. RESULTS Methicillin -resist ant/ sensititive S. au-reus ( MRSA/ MSSA) and Methicillin - resistant/ sensit itive S . ep idermidis ( MRSEP/MSSEP) strains were morefrequently isolated from the ischemic ulcers compared to those from the simple neuropat hic ones. The isolates fromWagner 3 and 4 -grade ulcers possessed higher percentage of drug resistant strains than those from Wagner 1 and 2 -grade ulcers. Compared to MSSA, the MRSA strains were more frequently isolated from Wagner 3 and 4 -gradeulcers ( P< 0. 05) . Multidrug -resistant strains accounted for 60. 7% and 72. 9% in S. aureus and S. epidermidisisolates, respectively. MRSA ( 23, to SAU ) and MRSEP ( 16, to SEP) accounted for 27. 4% and 33. 3% ,respectively. All of them were multidrug - resistant strains. The resistant rates of MRSA and MRSEP to -lactamsand macrolides w ere both over 75. 0% , the resistante rate to fluoroquinolones w as between 56. 3% and 73. 9% .MRSEP strains had a significantly higher resistante rate to trimet hoprim -sulfamethoxazole than MRSA ( 81. 3% vs收稿日 期: 2010 -10 -11 ; 修回日 期: 2010 -11 -15基金项目 : 天津市自 然科学基金资助项目 (08JCZDJC25100)通讯作者: 李代清, E -mail: daiqingli68@ 126. com481中华医院感染学杂志 2011 年第 21 卷第 3 期 Chin J Nosocomiol Vol. 21 No. 3 2011