摘要
目的 总结糖尿病足(DF)合并类鼻疽伯克霍尔德菌(BP)感染的临床特征、药敏特点和治疗方法。方法 回顾分析2012年1月至2022年3月海南医学院第二附属医院收治的64例DF合并BP感染病人的临床表现、微生物抗菌药物敏感性及治疗手段。结果 64例DF合并BP感染病人中,60例有发热症状、34例有白细胞升高、均有C反应蛋白(CRP)和降钙素原(PCT)升高、14例合并肝或脾脓肿、30例出现肝功能不全、20例出现肾功能不全、18例合并感染性休克。64株BP对大多数常见的抗生素敏感性较差,但均对亚胺培南、美罗培南和复方磺胺甲唑敏感。所有病人均使用胰岛素积极控制血糖,大多数静脉应用碳青霉素烯类抗菌素约6周,出院后继续使用复方磺胺甲唑治疗。最终22例治愈,30例好转,8例未愈,4例死亡。死亡病例均合并多器官功能障碍。结论 DF合并BP主要表现为发热、CRP和PCT明显升高、合并肝或脾脓肿和肝肾功能不全,易出现感染性休克。对高度怀疑BP感染病人应多次进行培养,并及早静脉应用碳青霉素烯类抗菌素可能有助于改善预后。
Objective To summarize the clinical characteristics,drug sensitivity and treatment of patients with diabetic foot(DF)complicated with burkholderia pseudomallei(BP)infection.Methods 64 patients with DF complicated with BP infection were retro⁃spectively analyzed in terms of clinical manifestations,antimicrobial sensitivity and treatment in the Second Affiliated Hospital of Hain⁃an Medical University from January 2012 to March 2022.Results Among the 64 patients with DF combined with BP infection,60 had fever,34 had leukocyte elevation,all had c-reactive protein(CRP)and procalcitonin(PCT)elevation,14 had liver and spleen abscess,30 had liver insufficiency,20 had renal insufficiency,and 18 had septic shock.Sixty-four strains of BP showed poor sensitivity to most common antibiotics,but all were sensitive to imipenem,meropenem and cotrimoxazole.All patients were treated with insulin for glyce⁃mic control,and most were treated with intravenous carbapillicene antibiotics for approximately 6 weeks.Cotrimoxazole was continued after discharge.Finally,22 cases were cured,30 cases improved,8 cases were not cured and 4 cases died.All the deaths were compli⁃cated with multiple organ dysfunction.Conclusions DF combined with BP mainly showed fever,significantly increased CRP and PCT,combined with liver and spleen abscess and liver and kidney dysfunction,and prone to septic shock.In patients with highly sus⁃pected BP infection,repeated cultures and early intravenous administration of carbopenicillene antibiotics may help improve prognosis.
作者
陈宗存
符沙沙
陈金逸
赖舒畅
符茂雄
CHEN Zongcun;FU Shasha;CHEN Jinyi;LAI Shuchang;FU Maoxiong(Department of Endocrinology,The Second Affiliated Hospital of Hainan Medical University,Haikou,Hainan 570311,China;Department of Respiratory,the Central South University Xiangya School of Medicine Affiliated Haikou Hospital,Haikou,Hainan 570208,China)
出处
《安徽医药》
CAS
2024年第2期256-259,共4页
Anhui Medical and Pharmaceutical Journal
基金
海南省自然科学基金面上项目(821MS138)
海南省重点研发计划(ZDYF2021SHFZ080)
海南省卫生计生行业科研项目(21A200041)。
关键词
糖尿病足
类鼻疽伯克霍尔德菌
药物敏感性
病原菌
Diabetic foot
Burkholderia pseudomallei
Drug sensitivity
Pathogenic bacteria
