Changing microbiological profile of pathogenic bacteria in diabetic foot infections: time for a rethink on which empirical therapy to choose?
Changing microbiological profile of pathogenic bacteria in diabetic foot infections: time for a rethink on which empirical therapy to choose?
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DOI：
10.1007/s00125-010-1893-7
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发表时间：
2011-01-01
期刊：
影响因子：
8.2
通讯作者：
Mishra, S. K.
中科院分区：
文献类型：
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作者：
Ramakant, P.;Verma, A. K.;Mishra, S. K.
我们对印度糖尿病足部溃疡的细菌病原学和药敏模式进行了研究，对1991年至2008年期间447名住院患者的记录进行了回顾分析，以比较细菌病原学和药物敏感性模式。在治疗期间对同一伤口的前三种连续培养进行了评估。在1,632种培养中，66%是多菌的，23%是单菌的，11%是无菌的。在单一微生物组中，14%(n=228)的细菌培养为革兰氏阴性，9%(n=147)的培养为革兰氏阳性。首次培养最常见的病原菌为铜绿假单胞菌(20.1%)、金黄色葡萄球菌(17.2%)和大肠埃希菌(16.3%)。第三次培养结果显示铜绿假单胞菌(15.3%)和大肠埃希菌(14.2%)持续存在。革兰阴性菌占25.3%，革兰氏阳性菌占15.1%，p<；0.05)。1999年前后的药敏结果分别为：哌拉西林-他唑巴坦74%对66%(p<；0.005)，亚胺培南77%对85%(p<；0.005)，头孢哌酮-舒巴坦47%对44%(p<；0.005)，阿米卡星62%对78%(p<；0.005)，头孢曲松41%对36%(p<；0.005)，阿莫西林-克拉维酸51%对43%(p<；0.05)，克林霉素43%对36%(p<；0.005)0.005)。与西方不同，在印度，糖尿病足感染患者的伤口中发现革兰氏阴性细菌一直占主导地位。感染多重微生物多重耐药的革兰氏阴性杆菌是很常见的。三级医疗机构经验性抗菌治疗的政策需要改变。
We studied the bacterial aetiology and antibiotic sensitivity pattern of diabetic foot ulcers in India.Records of 447 hospitalised patients between 1991 and 2008 were retrospectively analysed between two time periods (before and after 1999) to compare bacterial aetiology and antimicrobial sensitivity patterns. The first three consecutive cultures from the same wound during treatment were evaluated.Of 1,632 cultures, 66% were polymicrobial, 23% monomicrobial and 11% sterile. In the monomicrobial group, 14% (n = 228) of cultures were Gram-negative, whereas 9% (n = 147) were Gram-positive. The most common pathogens in the first culture were Pseudomonas aeruginosa (20.1%), Staphylococcus aureus (17.2%) and Escherichia coli (16.3%). Results for the third cultures showed persistence of P. aeruginosa (15.3%) and E. coli (14.2%). Gram-negative isolates dominated over Gram-positive ones (25.3% vs 15.1%, p < 0.05). Antibiotic sensitivity patterns before and after 1999 were: piperacillin-tazobactam 74% vs 66% (p < 0.005), imipenem 77% vs 85% (NS), cefoperazone-sulbactam 47% vs 44% (p < 0.005), amikacin 62% vs 78% (NS), ceftriaxone 41% vs 36% (p < 0.005), amoxicillin-clavulanate 51% vs 43% (p < 0.05) and clindamycin 43% vs 36% (p < 0.005), respectively.Unlike in the West, in India Gram-negative bacteria were found to have always been dominant in the wounds of patients with diabetic foot infections. Infection with polymicrobial multidrug-resistant Gram-negative bacilli is common. The policy of empirical antimicrobial therapy at tertiary care needs to be changed.