儿童口腔颌面间隙感染病原菌耐药研究

Study on the drug resistance of pathogens causing an oral and maxillofacial space infection in children

目的分析儿童口腔颌面间隙感染病原菌耐药情况,以指导临床治疗。方法共收集261例儿童口腔颌面部间隙感染患者临床资料,取患者口腔样本从中分离鉴定病原菌,并采用K-B法分析耐药性。结果261例感染患者中,牙源性感染157例,腺源性感染54例,外伤性感染29例,其他来源感染21例。咀嚼肌间隙、颊间隙、眶下间隙、颌下间隙、咽旁间隙、其他部位感染分别为82、63、37、29、23和27例。共分离144株病原菌,革兰阳性菌91株(63.19%),革兰阴性菌47株(32.64%),真菌6株(4.17%)。真菌均为白色假丝酵母菌。65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、左氧氟沙星的耐药株数分别为39、26、20、13、18和16株,耐药率分别为60.00%、40.00%、30.77%、20.00%、27.69%和24.62%,对万古霉素均敏感。19株肺炎链球菌耐药株数分别为11、9、6、4、2和1株,耐药率分别为57.89%、47.37%、31.58%、21.05%、10.53%和5.26%,对万古霉素均敏感。24株肺炎克雷伯菌对甲硝唑、庆大霉素、四环素、头孢他啶、环丙沙星、亚胺培南的耐药株数分别为4、7、7、9、7和0株,耐药率分别为16.67%、29.17%、29.17%、37.50%、29.17%和0.00%。13株普雷沃菌耐药株数分别为2、7、6、3、6和0株,耐药率分别为15.38%、53.85%、46.15%、23.08%、46.15%和0.00%。13株普雷沃菌携带cfxA、ermF、tetQ、nimA、nimB、nimC基因菌株分别为4株(30.77%)、7株(53.85%)、6株(46.15%)、2株(15.38%)和1株(7.69%),未检出nimC。结论患儿口腔颌面部间隙感染来源主要为牙源性,感染部位主要发生在咀嚼肌间隙。金黄色葡萄球菌是最主要感染病原菌类型;革兰阳性菌感染治疗可选用万古霉素,革兰阴性菌感染治疗可选用亚胺培南,但应合理用药。

Objectives To analyze the drug resistance of pathogens causing an oral and maxillofacial space infection in children in order to guide clinical treatment of those infections.Methods Clinical data on a total of 261 children with an oral and maxillofacial space infection were collected,and pathogens were isolated and identified from oral samples.Drug resistance was analyzed using the K-B method.Results Of the 261 patients,157 had a dental infection,54 had a glandular infection,29 had a trauma-related infection,and 21 had an infection from some other source.The site of infection was the masticatory muscle space in 82 patients,the buccal space in 63,the suborbital space in 37,the submandibular space in 29,the parapharyngeal space in 23,and some other site in 27.One hundred and forty-four strains of pathogens were isolated,included 91 strains of Gram-positive bacteria(63.19%),47 strains of Gram-negative bacteria(32.64%),and 6 strains of fungi(4.17%).Sixty-five strains of Staphylococcus aureus were detected.Thirty-nine were resistant to ampicillin at a rate of 60.00%,26 were resistant to piperacillin at a rate of 40.00%,20 were resistant to cefalexin at a rate of 30.77%,13 were resistant to ciprofloxacin at a rate of 20.00%,18 were resistant to imipenem at a rate of 27.69%,and 16 were resistant to levofloxacin at a rate of 24.62%,but strains were sensitive to vancomycin.Nineteen strains of Streptococcus pneumoniae were detected.Eleven were resistant to ampicillin at a rate of 57.89%,9 were resistant to piperacillin at a rate of 47.37%,6 were resistant to cefalexin at a rate of 31.58%,4 were resistant to ciprofloxacin at a rate of 21.05%,2 were resistant to imipenem at a rate of 10.53%,and 1 was resistant to levofloxacin at a rate of 5.26%,but strains were sensitive to vancomycin.Twenty-four strains of Klebsiella pneumoniae were detected.Four strains were resistant to metronidazole at a rate of 16.67%,7 were resistant to gentamicin at a rate of 29.17%,7 were resistant to tetracycline at a rate of 29.17%,9 were resistant to ceftazidime at a rate of 37.50%,7 were resistant to ciprofloxacin at a rate of 29.17%,and 0 were resistant to imipenem at a rate of 0.00%.Thirteen strains of Prevotella were detected.Two were resistant to resistant to metronidazole at a rate of 15.38%,7 were resistant to gentamicin at a rate of 53.85%,6 were resistant to tetracycline at a rate of 46.15%,3 were resistant to ceftazidime at a rate of 23.08%,6 were resistant to ciprofloxacin at a rate of 46.15%,and 0 were resistant to imipenem at a rate of 0.00%.cfxA was detected in 4(30.77%)of the 13 strains of Prevotella,ermF was detected in 7(53.85%),tetQ was detected in 6(46.15%),nimA was detected in 2(15.38%),and nimB was detected in 1(7.69%),but nimC was not detected.Conclusion The main source of an oral and maxillofacial space infection was a dental infection,and the main site of infection was the masticatory muscle space.S.aureus is the most prevalent pathogen.Vancomycin can be used in the treatment of a Gram-positive bacterial infection,and imipenem can be used in the treatment of a Gram-negative bacterial infection,but drugs should be used rationally.