Risk Factors for Multidrug-Resistant Organisms Infection in Diabetic Foot Ulcer.
Risk Factors for Multidrug-Resistant Organisms Infection in Diabetic Foot Ulcer.
复制标题
糖尿病足溃疡中多种耐药生物感染的危险因素。
DOI：
10.2147/idr.s359157
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发表时间：
2022
影响因子：
3.9
通讯作者：
Chang B
中科院分区：
文献类型：
--
作者：
Liu X;Ren Q;Zhai Y;Kong Y;Chen D;Chang B
本研究旨在分析糖尿病足溃疡（DFU）的微生物学特征和耐多药菌（MDROs）的耐药性，揭示MDROs的潜在危险因素。这为早期经验性抗生素治疗提供了依据。本研究纳入2020年5月至2021年11月在天津医科大学朱贤一纪念医院及代谢病医院就诊的348例糖尿病足溃疡患者。共培养细菌475株，其中耐多药细菌240株，占51%。采用二元logistic回归分析危险因素。首先采用单因素分析计算变量的p值，然后对p < 0.1的变量进行多因素分析，分析独立危险因素。多变量分析中p < 0.05的危险因素视为独立危险因素。关联强度用比值比和95%置信区间表示。单变量logistic回归分析显示，既往住院、既往抗生素治疗、溃疡大小bbb4cm2、手术治疗、d -二聚体、CRP与DFU患者MDRO感染相关。多因素logistic回归分析显示，既往住院（OR = 1.91; 95% CI = 1.11-3.28; p = 0.02）、溃疡大小bbb4cm2 （OR = 1.68; 95% CI = 1.03-2.76; p = 0.04）、手术治疗（OR = 2.14; 95% CI = 1.03-4.47; p = 0.04）、CRP （OR = 1.01; 95% CI = 1.00-1.01; p = 0.03）是糖尿病足患者MDROs感染的独立危险因素。耐药分析可能提示天津地区鲍曼不动杆菌的比例和耐药率发生了变化。既往住院史、溃疡大小bbb4cm2、手术治疗、CRP是糖尿病足患者MDROs感染的独立危险因素。识别这些危险因素有助于我们早期识别糖尿病足合并MDRO感染的高危患者。加强对高危患者的关注，采取更积极的隔离措施，可能会降低糖尿病足患者MDRO感染的发生率。
The aim of this study is to analyze the microbiological characteristics of diabetic foot ulcer (DFU) and drug resistance of multidrug-resistant organisms (MDROs) and to reveal the potential risk factors for MDROs. This provides a basis for early empiric antibiotic treatment. This study included 348 patients with diabetic foot ulcer in Chu Hsien-I Memorial Hospital & Metabolic Disease Hospital of Tianjin Medical University between May 2020 and November 2021. A total of 475 strains of bacteria were cultured, among which 240 strains were multidrug-resistant bacteria, accounting for 51%. Binary logistic regression was used to analyze risk factors. First, univariate analysis was used to calculate the p value of variables, and then multivariate analysis was conducted for variables with p < 0.1 to analyze independent risk factors. Risk factors with p < 0.05 in multivariable analysis were considered as independent risk factors. The strength of the association was represented by odds ratio and 95% confidence interval. Univariable logistic regression analysis demonstrated that previous hospitalization, previous antibiotic therapy, ulcer size >4cm2, surgical therapy, D-dimer, and CRP were associated with MDRO infection in patients with DFU. Multivariate logistic regression analysis demonstrated that previous hospitalization (OR = 1.91; 95% CI = 1.11–3.28; p = 0.02), ulcer size >4cm2 (OR = 1.68; 95% CI = 1.03–2.76; p = 0.04), surgical therapy (OR = 2.14; 95% CI = 1.03–4.47; p = 0.04), and CRP (OR = 1.01; 95% CI = 1.00–1.01; p = 0.03) were independent risk factors for MDROs infection in diabetic foot patients. Drug resistance analysis may indicate that the proportion and drug resistance rate of Acinetobacter baumannii in Tianjin, China, have changed. Previous hospitalization, ulcer size >4cm2, surgical therapy and CRP were independent risk factors for MDROs infection in diabetic foot patients. Identifying these risk factors can help us identify the high-risk patients of diabetic foot with MDRO infection early. More attention to high-risk patients and more aggressive isolation precautions may reduce the incidence of MDRO infection in diabetic foot patients.