口腔颌面外科手术患者发生感染的病原菌特点及影响因素探讨

Pathogenic characteristics and factors influencing infections in patients undergoing oral and maxillofacial surgery

目的分析口腔颌面外科手术患者发生感染的病原菌特点并探讨其影响因素。方法2016年5月-2018年5月在本院行口腔颌面外科手术治疗的患者214例,采集相应临床标本进行细菌的培养鉴定并进行药敏试验;收集患者的临床资料,包括年龄、性别、体质量指数、手术时间、术中抗菌药物使用、误吸、是否发生感染及感染部位等,分析术后感染发生的相关因素。结果214例口腔颌面手术患者中发生术后感染29例(感染率为13.55%),感染部位主要为呼吸道及手术切口。29例感染患者的临床标本共分离出49株病原菌,其中革兰阴性菌占71.43%,主要菌种铜绿假单胞菌对哌拉西林及头孢唑林的耐药率为42.86%和71.43%;革兰阳性菌占29.35%,主要菌种金黄色葡萄球菌对庆大霉素耐药率为57.14%,对万古霉素敏感;真菌占6.12%。单因素分析显示,年龄、手术时间、术中抗菌药物使用及误吸等为口腔颌面术后感染发生相关因素。结论口腔颌面术后感染的主要致病菌为革兰阴性菌,且对抗菌药物有一定的耐药性。年龄、手术时间、术中抗菌药物使用及误吸为患者术后感染发生的影响因素,可为口临床提供参考。

Objective To investigate pathogenic characteristics and factors influencing infections in patients undergoing oral and maxillofacial surgery.Methods Subjects were two hundred and fourteen patients who underwent oral and maxillofacial surgery at this Hospital from May 2016 to May 2018.Clinical data on patients,including age,sex,body mass index,operating time,use of antibiotics,invasive surgery,aspiration,the incidence of an infection,and the site of the infection,was collected and retrospectively analyzed.Clinical specimens from patients with an infection were subjected to microbial culture and drug susceptibility testing,and factors influencing the development of an infection were analyzed in patients with an infection and patients without an infection.Results Of 214 patients,29 had an infection(rate of infection:13.55%).The main sites of infection were the respiratory tract and surgical site.A total of 49 strains of pathogens were isolated from 29 patients with an infection.Gram-negative bacteria accounted for 71.43%of the isolates.Pseudomonas aeruginosa was the main strain.P.aeruginosa was resistant to piperacillin at a rate of 42.86%and to cefazolin at a rate of 71.43%.Gram-positive bacteria accounted for 29.35%of isolates.Staphylococcus aureus was resistant to gentamicin at a rate of 57.14%and sensitive to vancomycin.Fungi accounted for 6.12%of the isolates.Age,operating time,intraoperative use of antibiotics?and aspiration were associated with the development of an infection after oral and maxillofacial surgery.Conclusion Gram-negative bacteria were the main pathogens causing an infection in patients undergoing oral and maxillofacial surgery.Factors influencing the development of a postoperative infection were age,operating time,intraoperative use of antibiotics,and aspiration.The monitoring of these factors should be enhanced in order to prevent post-operative infections.