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目的分析糖尿病合并败血症患者的病原菌种类及其对抗菌药物的耐药性,为合理选用抗菌药物提供依据。方法对2011年1月至2014年7月在浙江大学医学院附属第二医院确诊的80例糖尿病合并败血症患者的临床资料、血培养和药敏结果进行回顾性分析。结果 80例糖尿病合并败血症患者中原发感染部位以泌尿道感染最多,其次为呼吸道感染。检出病原菌中革兰阴性菌44株,占55.0%,其中大肠埃希菌38株,肺炎克雷伯菌6株;革兰阳性菌36株,占45.0%,其中葡萄球菌属24株,链球菌属12株。药敏试验中大肠埃希菌对环丙沙星、左氧氟沙星、氨苄西林和哌拉西林耐药率达50.0%以上;肺炎克雷伯菌对氨苄西林、环丙沙星、左氧氟沙星、呋喃妥因、哌拉西林、头孢西丁、头孢唑林、头孢呋辛和妥布霉素100.0%耐药;葡萄球菌属对苯唑西林、克林霉素和青霉素G耐药率高达75.0%以上。结论糖尿病并发败血症患者以革兰阴性杆菌感染为主,但革兰阳性菌感染率与以往报道比有上升趋势,可选用碳青霉烯类抗菌药物以及头孢含β-内酰胺酶抑制剂的复合药作为经验性治疗,考虑阳性菌感染时首选万古霉素,同时要尽早行血培养,及时更换为敏感抗生素,减少耐药菌株的出现,降低糖尿病合并败血症的病死率。
Objective To analyze the types of pathogens in patients with diabetes mellitus and their resistance to antimicrobial agents, so as to provide a basis for rational use of antimicrobial agents. Methods The clinical data, blood culture and drug susceptibility results of 80 patients with diabetes mellitus complicated with sepsis diagnosed in the Second Affiliated Hospital of Zhejiang University from January 2011 to July 2014 were analyzed retrospectively. Results 80 cases of diabetic patients with sepsis infection in the primary site of urinary tract infection, followed by respiratory tract infection. Among the pathogenic bacteria, 44 were Gram-negative bacteria, accounting for 55.0%, including 38 strains of Escherichia coli and 6 strains of Klebsiella pneumoniae; 36 strains of Gram-positive bacteria, accounting for 45.0%, of which 24 were Staphylococcus, 12 strains of cocci. The resistance rate of Escherichia coli to ciprofloxacin, levofloxacin, ampicillin and piperacillin in drug susceptibility test was more than 50.0%. Klebsiella pneumoniae was resistant to ampicillin, ciprofloxacin, levofloxacin, nitrofurantoin, Xilin, cefoxitin, cefazolin, cefuroxime and tobramycin 100.0% resistant; Staphylococcus oxacillin, clindamycin and penicillin G resistant rates as high as 75.0%. Conclusions Gram-negative bacilli are the main pathogens in patients with diabetes mellitus and septicemia. However, the infection rate of Gram-positive bacteria is on an upward trend compared with the previous reports. Carbapenems antibiotics and cephalosporins containing β-lactamase inhibitors As an empirical treatment of drugs, consider the preferred vancomycin infection of positive bacteria, while blood culture as soon as possible, and promptly replaced with sensitive antibiotics to reduce the emergence of drug-resistant strains and reduce the mortality of diabetic patients with septicemia.