口腔颌面部间隙感染患者病原学、耐药性特点及CRP、PCT、D-D与创面愈合的关系研究

Etiology,Drug Resistance Characteristics and Relationship Study between CRP,PCT,D-D and Wound Healing in Patients with Oral and Maxillofacial Space Infection

目的:探讨口腔颌面部间隙感染(OMSI)患者病原学、耐药性特点及血清C反应蛋白(CRP)、降钙素原(PCT)、D-二聚体(D-D)与治疗后创面愈合情况的关系。方法:回顾性分析我院感染科于2018年7月-2021年5月收治的188例OMSI患者的临床资料,分析OMSI患者的感染部位、感染来源,感染病原学特点、耐药性特点;所有患者均采用封闭负压引流(VSD)技术治疗,根据治疗后创面愈合情况分为创面愈合良好组(n=153)和创面愈合不良组(n=35),比较两组患者的血清CRP、PCT、D-D水平。结果:188例OMSI患者感染部位分布依次为颌下间隙(34.57%)、眶下间隙(27.13%)、咀嚼肌间隙(17.02%)、颊间隙(11.17%)、咽旁间隙(10.11%),感染来源占比依次为牙源性(74.47%)、腺源性(14.89%)、其他(10.64%)。188例OMSI患者中共分离检测出337株病原菌,其中需氧菌172株(51.04%),厌氧菌101株(29.97%),需氧-厌氧菌64株(18.99%)。主要感染致病菌对青霉素G、氨苄西林、红霉素具有高耐药性,克林霉素和亚胺培南对需氧菌、厌氧菌、需氧-厌氧菌均具有较高活性。治疗后创面愈合良好组CRP、PCT、D-D水平低于创面愈合不良组(P<0.05)。结论:OMSI患者以牙源性感染为主,感染部位多发生于颌下间隙和眶下间隙,病原菌类型多样且耐药情况较严重,临床治疗应合理应用抗菌药物,创面愈合良好患者血清CRP、PCT、D-D水平降低,因此,降低血清CRP、PCT、D-D水平可能有助于OMSI患者VSD术后创面愈合。

Objective:To investigate the etiology,drug resistance characteristics and the relationship between C-reactive protein(CRP),procalcitonin(PCT),D-dimer(D-D)and wound healing in patients with oral and maxillofacial space infection(OMSI).Methods:The clinical data of 188 patients with OMSI who were admitted to the Department of infectious diseases of our hospital from July 2018 to May 2021 were retrospectively analyzed,and the infection site,infection source,infection etiology characteristics and drug resistance characteristics of patients with OMSI were analyzed.All patients were treated with closed negative pressure drainage(VSD),and they were divided into good wound healing group(n=153)and poor wound healing group(n=35)according to the wound healing after treatment.Serum CRP,PCT and D-D levels of patients in the two groups were compared.Results:The infection sites of 188 patients with OMSI were submaxillary space(34.57%),infraorbital space(27.13%),masticatory muscle space(17.02%),buccal space(11.17%),parapharyngeal space(10.11%).The proportion of infection sources was odontogenic(74.47%),glandular(14.89%)and other(10.64%).A total of 337 pathogenic bacteria were isolated and detected from 188 patients with OMSI,included 172 strains(51.04%)aerobic bacteria,101 strains(29.97%)anaerobic bacteria,and 64 strains(18.99%)aerobic-anaerobic bacteria.The main pathogenic bacteria had high resistance to penicillin G,ampicillin and erythromycin,and low resistance to ciprofloxacin and ceftriaxone.Clindamycin and imipenem had high activity against aerobic bacteria,anaerobic bacteria and aerobic-anaerobic bacteria.After treatment,the CRP,PCT and D-D levels in good wound healing group were lower than those in poor wound healing group(P<0.05).Conclusions:Patients with OMSI are mainly odontogenic infection,and the infection sites are mostly in the submaxillary space and suborbital space.There are various types of pathogenic bacteria and their drug resistance is serious.Antibacterial drugs should be rationally applied in clinical treatment,and the serum CRP,PCT and D-D levels of patients with good wound healing are reduced.Therefore,reducing serum CRP,PCT and D-D levels may contribute to wound healing after VSD in patients with OMSI.