糖尿病足感染的微生物和炎症特征：严重程度分层分析
Microbiological and inflammatory profiles in diabetic foot infection: A severity-stratified analysis.
摘要(中文译文)
本研究分析了按感染严重程度分层的糖尿病足感染（DFI）患者的细菌谱、抗生素敏感性特征以及人中性粒细胞脂质运载蛋白（HNL）和降钙素原（PCT）的血清水平。对2018年1月至2024年5月期间入住延安大学附属医院内分泌代谢科的DFI患者的临床数据进行了回顾性分析。根据2015年美国传染病学会/国际糖尿病足分类系统工作组，患者被分为轻度、中度和重度感染组。比较各组的细菌病原体分布、抗生素敏感性和炎症标志物（HNL[ng/mL]和PCT[ng/mL）。在387名筛查患者中，208名（53.8%）细菌培养呈阳性。单菌感染160例（77.0%），多菌感染44例（21.2%）。革兰氏阳性（G+）细菌占分离物的58.2%（121/208），革兰氏阴性（G-）细菌占18.8%（39/208）。主要的革兰氏阳性（G+）细菌是金黄色葡萄球菌（52.1%）、表皮葡萄球菌（14.9%）、人型葡萄球菌（5.0%）和溶血葡萄球菌（5.0%），金黄色葡萄杆菌在所有严重程度组中明显更常见（P < .05). 常见的革兰氏阴性（G-）分离物包括大肠杆菌（28.1%）、肺炎克雷伯菌（15.4%）和产酸克雷伯氏菌（10.3%），各组之间没有显著差异。革兰氏阳性（G+）分离株对庆大霉素、万古霉素、苯唑西林和利奈唑胺表现出高度敏感性，组间没有差异。中重度组万古霉素敏感性明显高于轻度组（P < .05). 革兰氏阴性（G-）细菌在严重程度组中对氨苄西林、左氧氟沙星、头孢他啶、头孢哌酮-舒巴坦和美罗培南表现出一致的敏感性。HNL（ng/mL）、PCT（ng/mL）、白细胞计数（109/L）、中性粒细胞百分比（%）、C-反应蛋白（mg/L）和红细胞沉降率（mm/h）水平随着感染严重程度的增加而显著升高（P < .05). 然而，高敏C反应蛋白（mg/L）在各组之间没有显著差异。尽管在DFI中越来越多地观察到多种微生物感染，但革兰氏阳性（G+）细菌（尤其是金黄色葡萄球菌）仍然占主导地位。向革兰氏阴性（G-）病原体的转变与更高的感染严重程度有关。经验性抗生素治疗应以当地抗菌药物敏感性模式为指导。HNL和PCT与感染严重程度的强相关性表明它们在临床评估和管理中的潜在价值。
Abstract
This study analyzed the bacterial spectrum, antibiotic susceptibility profiles, and serum levels of human neutrophil lipocalin (HNL) and procalcitonin (PCT) in patients with diabetic foot infection (DFI) stratified by infection severity. A retrospective analysis was conducted on clinical data from DFI patients admitted to the Department of Endocrinology and Metabolism at Yan'an University Affiliated Hospital between January 2018 and May 2024. Based on the 2015 Infectious Diseases Society of America/ International Working Group on the Diabetic Foot classification system, patients were classified into mild, moderate, and severe infection groups. Bacterial pathogen distribution, antibiotic susceptibility, and inflammatory markers (HNL [ng/mL] and PCT [ng/mL]) were compared across groups. Among 387 screened patients, 208 (53.8%) had positive bacterial cultures. Monomicrobial infections were identified in 160 cases (77.0%), while polymicrobial infections accounted for 44 (21.2%). Gram-positive (G+) bacteria constituted 58.2% (121/208) of isolates, and Gram-negative (G-) bacteria represented 18.8% (39/208). The predominant Gram-positive (G+) bacteria were Staphylococcus aureus (52.1%), Staphylococcus epidermidis (14.9%), Staphylococcus hominis (5.0%), and Staphylococcus haemolyticus (5.0%), with S aureus being significantly more frequent across all severity groups (P < .05). Common Gram-negative (G-) isolates included Escherichia coli (28.1%), Klebsiella pneumoniae (15.4%), and Klebsiella oxytoca (10.3%), with no significant differences among groups. Gram-positive (G+) isolates exhibited high susceptibility to gentamicin, vancomycin, oxacillin, and linezolid, with no intergroup differences. Vancomycin susceptibility was significantly higher in moderate and severe groups compared to the mild group (P < .05). Gram-negative (G-) bacteria showed consistent susceptibility to ampicillin, levofloxacin, ceftazidime, cefoperazone-sulbactam, and meropenem across severity groups. Levels of HNL (ng/mL), PCT (ng/mL), white blood cell count (109/L), neutrophil percentage (%), C-reactive protein (mg/L), and erythrocyte sedimentation rate (mm/h) increased significantly with infection severity (P < .05). However, high-sensitivity C-reactive protein (mg/L) did not differ significantly among groups. Although polymicrobial infections were increasingly observed in DFI, Gram-positive (G+) bacteria (especially S aureus) remain predominant. A shift toward Gram-negative (G-) pathogens was associated with higher infection severity. Empirical antibiotic treatment should be guided by local antimicrobial susceptibility patterns. The strong correlation of HNL and PCT with infection severity suggests their potential value in clinical assessment and management.
如何引用
AMA
Ya-Li Zhu, Ting Bai, Yan Chang, Shu-Ting Cui, Rui Cao, Hai-Mei Du. Microbiological and inflammatory profiles in diabetic foot infection: A severity-stratified analysis.. Medicine. 2026; doi:10.1097/MD.0000000000049558.
APA
Ya-Li Zhu, Ting Bai, Yan Chang, Shu-Ting Cui, Rui Cao, Hai-Mei Du (2026). Microbiological and inflammatory profiles in diabetic foot infection: A severity-stratified analysis.. Medicine. https://doi.org/10.1097/MD.0000000000049558
GB/T 7714
Ya-Li Zhu, Ting Bai, Yan Chang, Shu-Ting Cui, Rui Cao, Hai-Mei Du. Microbiological and inflammatory profiles in diabetic foot infection: A severity-stratified analysis.[J]. Medicine, 2026 doi:10.1097/MD.0000000000049558.
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