To investigate the pathogenic bacteria affecting the wound infection of diabetic foot patients in a third-class hospital in Gansu Province, and analyze the relevant factors of wound infection, so as to provide theoretical basis for the later clinical treatment.

The case data of diabetes foot patients hospitalized in Gansu Provincial People′s Hospital from January 2017 to December 2021 were selected. Demographic information (age, gender), wound characteristics (diabetes course, wound duration, wound site), number of antibiotics applied, laboratory test indicators (red blood cell count, white blood cell count, hemoglobin, albumin, creatinine, cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, blood glucose, glycosylated hemoglobin, interleukin-6 and procalcitonin), wound bacterial culture results and drug sensitivity test results of the patients were collected and analyzed. Data were compared with chi-square test, single factor analysis and the multi-factor Logistic regression analysis.

(1)A total of 173 patients with diabetic foot were included in this study, of which 53 were in the age group of 51-60, it was the most of them, followed by 61-70 years old, 41-50 years old and 71-80 years old, accounting for 24.3%, 20.2% and 16.8% respectively. There were more men than women, 138 cases of males, accounting for 79.8%, and 35 cases of females, accounting for 20.2%. (2) In diabetic foot patients, the maximum duration of diabetes was 10-14 years (38 cases, accounting for 22.0%), and the maximum duration of wound was 15-30 days (53 cases, accounting for 30.1%). There were 185 wounds in 173 patients, of which the largest number were located in the toe (68 cases, accounting for 36.8%), followed by the sole (52 cases, accounting for 28.1%). (3) Laboratory test indicators results of patients showed that 60.1% of patients had red blood cell count below the normal range, 34.7% had white blood cell count above the normal range, 42.8% had hemoglobin below the normal range, and 86.1% had albumin below the normal range. Patients with creatinine above the normal range accounted for 20.8%, cholesterol above the normal range accounted for 11.6%, triglyceride above the normal range accounted for 23.7%, high density lipoprotein below the normal range accounted for 73.4%, low density lipoprotein above the normal range accounted for 12.7%, blood glucose above the normal range accounted for 82.1%, glycosylated hemoglobin above the normal range accounted for 77.5%, interleukin-6 above the normal range accounted for 77.5%, and procalcitonin above the normal range accounted for 68.2%. (4) A total of 257 samples were collected from 173 patients, of which 210 were positive and 47 were negative, with a positive rate of 81.7%. There were 120 strains of Gram-positive bacteria, accounting for 57.1%, 89 strains of Gram-negative bacteria, accounting for 42.4%, and 1 strain of fungus, accounting for 0.5%. Among Gram-positive bacteria, Staphylococcus aureus accounted for the highest proportion, 65 strains, 31.0%, followed by Enterococcus faecalis, 16 strains, accounting for 7.6%. Among Gram-negative bacteria, Enterobacter cloacae accounted for the highest proportion, 24 strains, 11.4%, followed by Escherichia coli, 21 strains, accounting for 10.0%. The results of drug sensitivity test showed that Staphylococcus aureus wassensitive to trimethoprim/sulfamethoxazole, vancomycin, linezolid and other antibiotics, and the sensitivity rate was 100.0%. The resistance rate to penicillin was 89.2%, followed by clindamycin (78.5%) and erythromycin (76.9%) respectively. Enterobacter cloacae was sensitive to meropenem, ertapenem, cefoperazone/sulbactam and levofloxacin with sensitivity rate of 100.0%, followed by amicacin, imipenem and cefepime with sensitivity rate of 95.8%. Escherichia coli was sensitive to meropenem, ertapenem, imipenem, tigacycline, cefoxitin and Amika magnitude, and the sensitivity rate was 100.0%. Among the 173 patients, 19 cases (11.0%) were treated with non antibiotics; there were 61 cases of 1 and 2 antibiotics, accounting for 35.3%; there were 25 cases of 3 antibiotics, accounting for 14.4%; 7 cases more than 4 antibiotics, accounting for 4.0%. (5) Analysis of 17 factors related to infection in diabetic foot patients showed that there were significant differences in wound duration, number of antibiotics applied, white blood cell count, hemoglobin, albumin, high-density lipoprotein, creatinine, glycosylated hemoglobin, interleukin-6, and procalcitonin (P<0.05). Further Logistic regression analysis showed that the factors related to wound infection were wound duration, antibiotic use and high density lipoprotein (OR=1.530, 1.923, 2.587, P<0.05).

Staphylococcus aureus and Enterococcus faecalis are the main Gram-positive bacteria, while Enterobacter cloacae and Escherichia coli are the main Gram-negative bacteria in the culture of wound pathogens in patients with diabetes foot; the independent risk factors of infection in patients with diabetes foot were long wound formation time, abuse of antibiotics and low high-density lipoprotein.