中国临床药学杂志

目的 探讨下肢静脉性和动脉性溃疡感染的病原菌分布特点、耐药情况及患者转归情况，为临床制订合理、有效的抗感染方案提供依据。方法 收集2019年1月至2024年1月收治的下肢溃疡病例546例，分为下肢静脉性溃疡组（A组）338例和下肢动脉性溃疡组（B组）208例，统计并分析下肢创面分泌物的病原菌分布情况、药敏结果、抗菌药物使用情况和抗感染有效率。结果 B组年龄高于A组（P<0.05）；有吸烟史和饮酒史，以及合并基础疾病的病例占比高于A组（P<0.01）。A组和B组检出革兰阳性菌的病例分别占52.2%和46.7%。2组检出的金黄色葡萄球菌对青霉素、氨苄西林及克林霉素耐药率较高，对苯唑西林、阿莫西林/克拉维酸及左氧氟沙星耐药率较低；铜绿假单胞菌对头孢唑林及氨苄西林/舒巴坦耐药率较高，对头孢他啶及头孢哌酮/舒巴坦耐药率较低。根据药敏结果，A组在初始经验性抗感染治疗方案上进行调整的药物多为大环内酯类药物、头霉素类药物、氧头孢烯类药物、第1代和第2代头孢菌素类药物；B组在初始经验性抗感染治疗方案上进行调整的药物多为大环内酯类药物、第1代和第2代头孢菌素类药物、头霉素类药物和喹诺酮类药物。A组和B组使用率最高的抗菌药物分别为喹诺酮类药物和β-内酰胺类药物/β-内酰胺酶抑制剂。治疗后，A组的抗感染有效率和好转病例占比均高于B组（P<0.01）。结论 下肢静脉性和动脉性溃疡感染病原菌以金黄色葡萄球菌和铜绿假单胞菌为主。临床诊断为静脉性溃疡感染者，可优先选用喹诺酮类药物以覆盖金黄色葡萄球菌或铜绿假单胞菌；而诊断为动脉性溃疡感染者，则可优先选用β-内酰胺类药物/β内酰胺酶抑制剂以覆盖革兰阴性菌和厌氧菌。

AIM To explore the distribution characteristics of pathogenic bacteria, drug resistance situation, and the patient outcomes of venous and arterial ulcers infected in the lower extremities, to provide a basis for the clinical formulation of reasonable and effective anti-infection strategies. METHODS A total of 546 patients with lower extremity ulcers admitted from January 2019 to January 2024 were collected. They were divided into the lower extremity venous ulcer group(Group A) with 338 patients and the lower extremity arterial ulcer group(Group B) with 208 patients. The distribution of pathogenic bacteria in the secretions of lower extremity wounds, the results of drug sensitivity tests, the usage of antibacterial drugs, and the effective rate of anti-infection were statistically analyzed. RESULTS Group B had a higher age(P < 0.05) and higher proportions of patients with smoking history, drinking history, and underlying diseases(P < 0.01) compared with Group A. In Group A and Group B, the patients with detected Gram positive bacteria accounted for 52.2% and 46.7%, respectively. The rates of resistance of Staphylococcus aureus detected in both groups to penicillin, ampicillin and clindamycin were relatively high, while the rates of resistance to oxacillin, amoxicillin/clavulanic acid and levofloxacin were relatively low; Pseudomonas aeruginosa had a higher resistance rate to cefazolin and ampicillin/sulbactam, and the resistance rate to ceftazidime and cefoperazone/sulbactam was lower. Based on the results of drug sensitivity tests, the drugs adjusted in the initial empirical anti-infection treatment plan of Group A were mostly macrolide drugs, cephamycin drugs, oxacepinene drugs, and first-and second-generation cephalosporin drugs; while the drugs adjusted in the initial empirical anti-infection treatment plan of Group B were mostly macrolide drugs, first-and second-generation cephalosporin drugs, cephamycin drugs and quinolone drugs. The most frequently used antibacterial drugs in Group A and Group B were quinolone drugs and β-lactam drugs/β-lactamase inhibitors. After treatment, the anti-infection effectiveness rate and the proportion of improved cases in Group A were higher than those in Group B(P < 0.01). CONCLUSIONS The pathogenic bacteria causing infections in lower extremity venous and arterial ulcers are mainly Staphylococcus aureus and Pseudomonas aeruginosa. For patients diagnosed with venous ulcer infections, quinolones can be given priority to cover Staphylococcus aureus or Pseudomonas aeruginosa. For patients diagnosed with arterial ulcers, β-lactam/β-lactamase inhibitors can be preferred to cover Gram-negative bacteria and anaerobic bacteria.