Study On The Pathogenic Characteristics And Drug Resistance Of Different TCM Syndromes In Patients With Diabetic Foot Ulcers

Objective:To explore the distribution of pathogenic bacteria of different TCM Syndrome Types in patients with diabetic foot ulcer,the corresponding drug sensitivity test results and the risk factors related to drug resistance,in order to guide the clinical use of sensitive antibiotics and to avoid the emergence of multidrug resistant strains.It provides a certain guiding value for the prevention and treatment of diabetic foot by Chinese and Western medicine.Methods:This study is a retrospective analysis of medical records.A total of 115 patients with diabetic foot ulcers admitted in Dongzhimen Hospital of Beijing University of Chinese Medicine from January 2014 to December 2018 were selected.The basic,Elements of TCM Syndrome and pathogenic data of the selected patients were collected.Firstly,the TCM syndrome type was unified according to the relevant guidelines.The distribution and drug sensitivity test of pathogens in different TCM syndromes were analyzed.Additionally,36 cases of diabetic foot with MDRMs infection were selected as case group and the rest 79 cases as control group.The clinical data of two groups were compared.Result:1.In the culture of 115 cases of diabetic foot ulcer secretions,82 cases were positive for bacteria culture and 33 were negative,and 107 strains were cultured.Among them,there were 48 Gram-positive bacteria(44.86%),55 Gram-negative bacteria(51.40%),and 4 fungi(3.74%).Gram-positive bacteria were common with Enterococcus faecalis,Staphylococcus aureus,Staphylococcus epidermidis and Streptococcus.To vancomycin,nitrofurantoin,linezolid with high sensitivity and to penicillin G,cefazolin and erythromycin Resistanted with resistance.Gram-negative bacteria were common in Escherichia coli,Pseudomonas aeruginosa,Klebsiella pneumoniae,proteus common and Acinetobacter Bauman.To carbapenems(such as meropenem,imipenem),fourth generation cephalosporins and piperacillin with high sensitivity.The resistance to cefazolin and ampicillin was more serious,and the second,third generation cephalosporins were resistant to different degrees.Fungi were Candida albicans and Candida albicans,which were sensitive to the clinical antifungal agents.2.Blood stasis syndrome was the highest in 115 cases of patients with TCM syndrome types,followed by Qi and blood deficiency,dampness heat,toxic heat and Yin syndrome.82 cases of bacterial culture positive,blood stasis syndrome was the highest,followed by dampness heat,Qi and blood deficiency,toxic heat and Yin syndrome.Syndromes in 33 cases of bacterial culture negativeare was Qi and blood deficiency,blood stasis,toxic heat and Yin syndrome,dampness heat.3.The multivariate logistics regression analysis indicated that the risk factors for the MDRMs infections in the diabetic foot patients include the previous use of antibiotics for a long time,hospitalization frequency more than 2 times per year due to same wound,neurological ischemic wounds and complication of osteomyelitis(P<0.05).Conclusion:1.The positive rate of our hospital patients with diabetic foot ulcer was 71.30%,mainly by Gram negative bacteria(51.40%),to carbopenems(such as meropenem,imipenem),fourth generation cephalosporins and piperacillin with high sensitivity.Gram positive cocci(44.86%),to vancomycin,nitrofurantoin,linezolid with high sensitivity.Fungi were rare and sensitive to current antifungal drugs.2.The distribution of TCM syndrome type is the most of blood stasis syndrome.In the blood stasis syndrome,gram-negative bacteria are most common,Escherichia coli and Klebsiella pneumoniae are the main factors.Gram-positive bacteria were mainly Staphylococcus epidermidis and Enterococcus faecalis.In the hygrothermal toxin syndrome,gram positive coccus was most and Enterococcus faecalis and Staphylococcus aureus were common.Gram-negative bacteria were mainly Pseudomonas aeruginosa and Escherichia coli.In the Qi and blood deficiency,gram-negative bacteria were most,and Escherichia coli and Klebsiella pneumoniae were most common.In the Poison Yin Syndrome,gram positive bacteria than gram negative bacteria,respectively Enterococcus faecalis,Staphylococcus aureus and Escherichia coli,Pseudomonas aeruginosa were more common.3.The risk factors for the MDRMs infections In the diabetic foot patients include the previous use of antibiotics for a long time,hospitalization frequency more than 2 times per year due to same wound,neurological ischemic wounds and complication of osteomyelitis.4.Timely control of infection is the key link in the treatment of diabetic foot.It is necessary to have a comprehensive treatment strategy,not only to do the early microbial culture and drug sensitivity test,but also to choose effective antibiotics before the results are reported,to avoid the risk factors of MDRMs infection,to improve the clinical effect and to improve the prognosis of the patients.