口腔颌面部间隙感染的病原学分析及危险因素研究

Etiology of oral and maxillofacial space infections and risk factors

目的探讨口腔颌面部间隙感染的病原学分布,并分析感染出现的危险因素。方法选取2014年1月-2016年6月医院收治的患有口腔疾病的患者437例作为研究对象,调查住院期间患者口腔颌面部间隙的感染率,通过对患者口腔颌面部间隙感染的分泌物进行培养及鉴定,分析感染的病原学分布,细菌培养采用需氧培养和厌氧培养两种模式,运用单因素及多因素Logistic线性回归分析方法探讨感染的危险因素。结果 437例患者发生口腔颌面部间隙感染39例,感染率为8.9%,共检出病原菌73株,其中需氧菌37株,厌氧菌15株,兼氧菌21株,感染来源主要为牙源性感染;单因素分析结果表明:高龄(≥60岁)、合并糖尿病、应用激素、医源性操作不当等情况的患者相对而言更容易出现口腔颌面部间隙感染,差异有统计学意义(P<0.05),logistic回归模型多因素分析,显示:高龄(≥60岁)、合并糖尿病、医源性操作不当为口腔颌面部感染的独立危险因素,应用激素与感染无明显相关性。结论口腔颌面部间隙感染的影响因素较多,最常见的病原菌为金黄色葡萄球菌和草绿色链球菌,临床上应该针对高危因素采取对应预防措施,积极预防口腔颌面部间隙感染的发生。

OBJECTIVE To explore the etiology of oral and maxillofacial space infection and analyze the risk factors for the infection.METHODS A total of 437 patients with oral disease who were treated in the hospital from Jan2014 to Jun 2016 were recruited as the study objects,the incidence of oral and maxillofacial space infections was investigated during hospital stay,the secretions specimens that were obtained from the patients with oral and maxillofacial space infections were cultured,the isolated pathogens were identified,the etiological distribution of the infection was analyzed,the bacterial culture was carried out by means of aerobic culture and anaerobic culture,and the univariate analysis and multivariate logisticlinear regression analysis were performed to explore the risk factors for the infections.RESULTS Of the 437 patients,39had the oral and maxillofacial space infection,with the infection rate 8.9%.Totally 73 strains of pathogens were isolated,including 37 strains of aerobic bacteria,15 strains of anaerobic bacteria,and 21 strains of facultative bacteria.The odontogenic infection was the major infection source.The univariate analysis showed that the patients with no less than 60 years of age,complication of diabetic mellitus,use of hormones,and improper iatrogenic operation were more likely to have the oral and maxillofacial space infections（P〈0.05）.The multivariate logistic regression analysis indicated that the advanced age（no less than 60 years of age）,complication with diabetic mellitus,and improper iatrogenic operation were the independent risk factors for the oral and maxillofacial infections,however,the use of hormones was not remarkably associated with the infections.CONCLUSIONThere are a variety of influencing factors for the oral and maxillofacial space infections,and Staphylococcus aureus and Streptococcus viridans are the most common species of pathogens.It is necessary for the hospital to take targeted prevention measures aiming at the high risk factors and actively prevent the oral and maxillofacial space infections.