口腔颌面部间隙感染病原及菌株耐药性特征

Pathogenic characteristics in patients with an orofacial space infection and the role of drug resistance in biofilm formation

目的探究口腔颌面部间隙感染病原学特征及菌株耐药性与生物被膜形成,指导临床感染的防控。方法收集174例口腔颌面部间隙感染患者临床资料。取口腔脓液,鉴定病原菌类型,采用K-B法进行药敏试验。取单个金黄色葡萄球菌敏感株菌落和耐药株菌落,经结晶紫染色定量生物被膜形成能力。结果 174例口腔颌面部间隙感染患者,感染病因为牙源性、腺源性、外伤性、其他的患者数分别为106、33、21和14例,构成比分别为60.92%、18.97%、12.07%和8.05%。感染部位为眶下间隙、颌下间隙、咬肌间隙、颊间隙、咽旁间隙、其他的患者数分别为56、45、24、19、14和16例;共分离223株病原菌,其中包括金黄色葡萄球菌、肺炎链球菌、肺炎克雷伯菌、表皮葡萄球菌、其他病原菌分别为105、71、18、7和22株。金黄色葡萄球菌对氨苄西林、哌拉西林、头孢氨苄、环丙沙星、亚胺培南的耐药率分别为54.29%、42.86%、31.43%、23.81%和28.57%;肺炎链球菌耐药率分别为61.97%、49.30%、35.21%、25.35%和5.63%;肺炎克雷伯菌耐药率分别为55.56%、44.44%、44.44%、33.33%和5.56%。结晶紫染色金黄色葡萄球菌耐药株强黏附,部分重叠,大片团块形成了典型生物被膜结构。结论口腔颌面部间隙感染来源主要是牙源性感染,常累及眶下间隙感染。患者感染病原菌类型主要是金黄色葡萄球菌,其对多种药物产生了耐药性。耐药金黄色葡萄球菌可以形成强黏附的生物被膜,可能是其产生耐药性的最主要原因之一。

Objective To study pathogenic characteristics in patients with an orofacial space infection and the role of drug resistance in biofilm formation in order to guide the prevention and treatment of disease in clinical settings.Methods Clinical data on 174 patients with an orofacial space infection were collected.Pathogens in samples of oral pus were identified.Drug sensitivity testing was performed using the K-B method.The biofilm formation capacity of a single drugsensitive strain and a single drug-resistant strain of Staphylococcus aureus was quantified using crystal violet staining to further investigate the mechanism of drug resistance in pathogenic bacteria.Results In the 174 patients with an orofacial space infection,106(60.92%) had an infection of odontogenie origin,33(18.97%) had an infection of glandular origin,21(12.07%) had an infection due to trauma,and 14(8.05%) had an infection due to some other cause.The site of infection was the orbital space in 56 patients (32.18%),the mandibular space in 45(25.86%),the masseter space in 24 (13.79%),the buccal space in 19(10.92%),the parapharyngeal space in 14(8.05%),and some other site in 16 (9.20%).Two hundred and twenty-three strains of pathogenic bacteria were isolated from patients,including 105strains (47.09%) of S.aureus,71 strains (31.84%) of S.pneumoniae,18 strains (8.07%) of Klebsiella pneumoniae,7 strains (3.14%) of S.epidermis,and 22 strains (9.87%) of other pathogenic bacteria.The 105 strains of S.aureus were resistant to ampicillin at a rate of 54.29%,to piperacillin at a rate of 42.86%,to cephalosporin at a rate of 31.43%,to ciprofloxacin at a rate of 23.81%,and to imipenem at a rate of 28.57%.The 71 strains of S.pneumoniae were resistant to ampicillin at a rate of 61.97%,to piperacillin at a rate of 49.30%,to cephalosporin at a rate of 35.21%,to ciprofloxacin at a rate of 25.35%,and to imipenem at a rate of 5.63%.The 18 strains of K.pneumoniae were resistant to ampicillin at a rate of 55.56%,to piperacillin at a rate of 44.44%,to cephalosporin at a rate of 44.44%,to ciprofloxaein at a rate of 33.33%,and to imipenem at a rate of 5.56%.Drug-sensitive S.aureus had limited adhesion,but drug-resistant S.aureus was highly adhesive.Drug-resistant bacteria had indistinct boundaries and bound to each other,forming clumps and partial overlapping.The large clumps formed typical biofilm structures.However, drug-sensitive strains were scatter with less adhesion.Conclusion An orofacial space infection was mainly due to an odontogenic cause and often involved the suborbital space.The pathogenic bacterium causing infection was mainly S.au- reus,which had developed resistance to numerous drugs.Drug-resistant S.aureus formed a highly adhesive biofilm, which may be one of the main reasons for its drug resistance.