The Relationship Between Infection Types And Infectious Pathogens In Hospitalized Diabetic Foot Patients

Objective:To analyze the distribution of pathogen among diabetic foot ulcers(DFU)with different Wagner grades,among different IDSA/IWGDF infection degree,between acute or chronic wounds,between first-visit or referral patients with diabetic foot infection(DFI).Methods:A total of 496 DFI patients hospitalized in the Endocrinology Department of the Second Hospital of Hebei Medical University were collected in the study.Ulcer wound secretions and(or)deep tissues for pathogen culture were collected.SPSS 25.0 software was performed for statistics analysis.P<0.05 was considered statistically significant.Results:A total of 708 strains of pathogen were cultivated,including315(44.49%)strains of Gram-negative bacilli(GNB),387(54.66%)Gram-positive organisms(GPOs),and 6(0.85%)fungal strains.Mixed bacterial infection increased with the increase of Wagner grade and degree of infection(0.17,0.11).The mixed bacterial infection rate in referral DFI patients(36.9%)was higher than that of first-visit DFI patients(29.2%).The mixed bacterial infection rate in chronic wound DFI patients(35.5%)were higher than acute wound patients(31.8%).The infection rate of GNB with Wagner4&5 grade was significantly higher than that of Wagner1&2 grade and Wagner3 grade(χ~2=25.60,P<0.001).The infection rate of GNB with moderate DFI infection was significantly higher than that in mild infection(χ~2=10.74,P=0.005).The infection rate of GNB in the referral DFI patients was significantly higher than that in the first-visit(χ~2=3.98,P=0.04).The GNB rate of in the chronic wound group was significantly higher than that in the acute(χ~2=7.68,P=0.01).Patients with Wagner 4&5 grade were mainly in Gram-negative-Enterobacteriaceae(41.3%).As infection degree increased,the ratio of Gram-negative-Enterobacteriaceae tends to increase.The proportion of Gram-positive-cocci(57.29%)in the first-visit group was significantly higher than that in the referral group(46.90%)(P<0.05).Chronic wound group and acute wound group were mainly cocci-Gram-positive cocci(44.97%,57.43%).Logistic regression analysis showed that higher Fib level[OR=1.17,95%CI:1.02-1.34;area under the ROC curve(AUC)=0.56,95%CI:0.51-0.61,cut-off point of 5.03g/L]prompted mixed infection.Severe foot ulcers(Wagner grade 4&5)(OR=3.15,95%CI:1.94-5.11),low hemoglobin level[OR=0.98,95%CI:0.97-0.99;area under the ROC curve(AUC)=0.58,95%CI:0.53-0.63,the cut point was 115.5g/l]had a higher infection rate of GNB.Conclusions:The proportion of GNB and mixed infection are higher in Wagner4&5 grade,moderate and severe infection,chronic wound,referral patients.Patients with Wagner4&5 grade,or moderate and severe infection,or chronic wounds or referral are infected by mainly Enterobacteriaceae-Gram-negative bacilli.Patients in higher Wagner classification with lower hemoglobin level should pay attention to cover GNB infection,while with high fibrinogen level should pay attention to mixed infection.