老年糖尿病患者牙源性面颈部感染病原菌分布及药敏分析

目的探讨老年糖尿病患者牙源性面颈部感染的病原菌分布,耐药性和治疗方法.方法回顾性分析94例老年糖尿病患者牙源性面颈部感染的临床资料,采用法国生物梅里埃公司的VITEK-2全自动细菌鉴定和药敏分析系统进行菌株鉴定和药敏试验.对面颈部感染患者给予及时切开引流,根据细菌培养和药敏结果选择敏感抗生素治疗.结果94例患者共检出354株病原菌,其中8例(占8.51%)患者由一种细菌感染引起,其余86例(占91.49%)患者由≥2种细菌感染导致.需氧菌中检出率最高的细菌依次为肺炎克雷伯菌、金黄色葡萄球菌、草绿色链球菌、铜绿假单胞菌.厌氧菌中检出率最高的依次为脆弱类杆菌、消化链球菌、梭杆菌.检出的主要细菌对青霉素类、头孢类、喹诺酮类、氨基糖甙类有较高的耐药率.29例患者死亡,死亡率为30.85%,预后不良病例药敏结果显示细菌对抗生素表现出严重的多重耐药性.结论老年糖尿病患者牙源性面颈部感染病情的轻重与病原菌构成密切相关,疾病的预后与细菌的耐药情况密切相关.尽早进行细菌培养及药敏试验指导选用敏感抗生素和及时切开引流是救治成功的关键.

Objective To investigate the distribution and drug resistance of pathogens isolated from orofacial and neck odontogenic infections and explore treatment in elderly diabetic patients. Methods The retrospective analysis was taken on clinical data of 94 cases.French bioMerieum VITEK-2 compact system was applied in bacteria identification and drug sensitivity test. Patients were treated by proper antibiotic,surgical drainage therapy. Results A total of 354 strains were isolated.Only 8 cases were infected by single bacteria,the other cases were infected by two or more of the bacteria. The most prevalent aerobe were Klebsiella pneumoniae,Staphylococcus aureus,Viridans Streptococci,P.Aeruginosa.The most prevalent anaerobe were Bacterooides fragilis,Peptostreptococcus,Fusobacterium.The main bacteria had high resistance rate to penicillin,cephalosporins,aminoglycosides, quinolones. 29 patients died,the mortality rate was 30.85%.Poor prognosis patients which drug sensitivity tests showed that the bacteria to antibiotics showed multidrug resistence were serious . Conclusions The severity of infections is closely related to the distribution of bacterial pathogens and the prognosis is closely related to the drug resistence. Proper antibiotics and surgical drainage in time are the keys to decrease mortality.