2型糖尿病足患者摩氏摩根菌β-内酰胺酶阳性菌株感染的危险因素

Risk factors for infection of Morganella morganii β-lactamase positive strains in type 2 diabetes patients with diabetic foot

  • 摘要:
    目的 探究2型糖尿病足(DF)患者摩氏摩根菌(Mm)的耐药性及影响超广谱β-内酰胺酶(ESBL)感染的危险因素,为临床治疗提供参考。
    方法 选择2020年1月—2023年3月于上海中医药大学附属上海市中西医结合医院治疗的DF患者的感染类标本,经培养首次检出Mm310例;根据是否产超光谱β-内酰胺酶(ESBL),分为产ESBL组(n=45)和非产ESBL组(n=265)。对Mm进行菌种鉴定和药敏试验。采用多因素logistic回归分析危险因素。使用逐步回归方法(SRM)筛选最重要的关联因素,用于构建风险预测模型并评价。
    结果 产ESBL和非产ESBL的Mm均对亚胺培南(IPM)和美罗培南(MEM)较敏感;与非产ESBL组相比,产ESBL组的Mm对其他抗生素[氨苄西林(AM)/舒巴坦(SU)除外]的耐药性均更高(P<0.05)。年龄≥60岁、合并低蛋白血症(HP)、联用抗菌药物、第3代头孢菌素用药史均是产ESBL菌株感染发生的独立危险因素(P<0.05)。SRM筛选出年龄、HP和第3代头孢菌素与产ESBL菌株感染关联最大,将该3个因素纳入多元logistic回归预测模型。P=0.80时约登指数最高,预测效果最好,预测准确度为89.35%,灵敏度为86.67%,特异度为89.81%。模型评价结果显示,预测模型的区分度较好,准确度较高。
    结论 产ESBL的Mm菌株对常用抗生素的耐药性较强,建议临床医师合理使用抗生素。年龄、HP、联用抗菌药物、第3代头孢菌素均是产ESBL菌株感染发生的独立影响因素;临床应根据危险因素对易感人群实施监测,加强感染管理。

     

    Abstract:
    Objective To explore the drug resistance of Morganella morganii (Mm) and the risk factors for extended-spectrum β-lactamase (ESBL) positive infection in type 2 diabetes foot (DF) patients with Mm, and to provide a reference for clinical treatment.
    Methods 310 samples of DF patients with Mm infection were collected from Shanghai Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 2020 to March 2023. The patients were selected for the first time to detect Mm bacteria through cultivation, and were divided into ESBL producing group (n=45) and non ESBL producing group (n=265). Bacterial identification and drug sensitivity experiments on Mm were conducted. Multivariate logistic regression analysis was used to analyze the risk factors. The stepwise regression method (SRM) was used to screen the most important correlation factors for constructing risk prediction model and its evaluation.
    Results Both ESBL producing and non ESBL producing Mm were sensitive to imipenem (IPM) and meropenem (MEM). Compared with the non ESBL producing group, the resistance of Mm in the ESBL producing group to other tested antibiotics [excluding ampicillin (AM)/sulbactam (SU)] was higher (P<0.05). Aged ≥60 years old, concomitant hypoproteinemia (HP), combined use of antibiotics, and history of third-generation cephalosporin use were all independent risk factors for the occurrence of ESBL producing strain infection (P<0.05). SRM screening identified age, HP, and use of third-generation cephalosporins as the most associated factors with ESBL producing strain infection, and these three factors were included in the multivariate logistic regression prediction model. After calculation, when P=0.80, the Jordan index was the highest and the prediction effect was the best. The prediction accuracy was 89.35%, the sensitivity was 86.67%, and the specificity was 89.81%. The model evaluation results showed that the predictive model has good discrimination and high accuracy.
    Conclusion The Mm strain producing ESBL has strong resistance to commonly used antibiotics, and it is recommended that clinical physicians use antibiotics reasonably. Age, HP, combined use of antibiotics, and use of third-generation cephalosporins are all independent risk factors for the occurrence of ESBL producing bacterial infections. Clinical monitoring should be carried out on susceptible populations based on risk factors, and infection management should be strengthened.

     

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