Shanghai yufang yixue (Aug 2024)
Risk factors for infection of Morganella morganii β-lactamase positive strains in type 2 diabetes patients with diabetic foot
Abstract
ObjectiveTo 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.Methods310 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.ResultsBoth 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.ConclusionThe 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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