种植体周围炎患者病原菌分布及其耐药性和感染危险因素分析

Distribution of pathogenic bacteria, drug resistance, and risk factors in patients with peri-implantitis

目的检测种植体周围炎患者病原菌种类,分析其耐药性及感染危险因素。方法 2015年1月-2018年1月在本院口腔科接受义齿种植的牙列缺损患者600例,采集龈沟底部标本,进行细菌的分离培养和鉴定,分析种植体周围炎患者感染病原菌种类,并进行药敏试验。对受检者进行问卷调查,分析相关发病因素。结果 600例种植牙患者共检出种植体周围炎86例,占14.33%。感染病原菌以厌氧菌为主,包括口腔链球菌(35.97%),牙龈卟啉单胞菌(21.07%),中间普雷沃菌(6.14%)和具核酸杆菌(4.63%)。分离的厌氧菌对阿莫西林、青霉素、氯霉素、红霉素、甲硝唑、克林霉素及苯唑西林的耐药率均>70%,但是对四环素和万古霉素耐药率均<5%。logistics回归分析,吸烟、种植体周围有剩余黏固剂、种植体周围粘膜退缩、慢性牙周炎病史等是种植体周围炎发生的风险因素(P<0.05)。结论种植体周围炎是常见病,其发生与吸烟、种植体周围有剩余黏固剂、种植体周围粘膜退缩、慢性牙周炎病史等有关。感染的致病菌以厌氧菌为主,该类菌对多种抗菌药耐药。建议治疗前应进行药敏试验,选用敏感抗生素治疗,以巩固患者的口腔修复效果。

Objectives To investigate the distribution of pathogenic bacteria and to analyze drug resistance and risk factors in patients with peri-implantitis.Methods Subjects were a total of 600 patients with dentition defects who received an implant in Dentistry at this Hospital from January 2015 to January 2018.Specimens were collected from the base of the gingival sulcus,and bacteria were isolated,cultured and identified.The pathogenic bacteria infecting patients were analyzed and a drug susceptibility test was performed.A survey was conducted via questionnaire to analyze relevant risk factors.Results Of 600 patients with implants,86(14.33%)had peri-implantitis.The pathogens responsible were mainly anaerobic bacteria,including Streptococcus oralis(35.97%),Porphyromonas gingivalis(21.07%),Prevotella(6.14%),and Fusobacterium nucleatum(4.63%).The resistance of anaerobic bacteria to amoxicillin,penicillin,chloramphenicol,erythromycin,metronidazole,clindamycin,and oxacillin was higher than 70%,but their resistance to tetracycline and vancomycin was lower than 5%.Smoking,residual cement around the implant,retraction of the mucosa around the implant,and a history of chronic periodontitis were all found to increase the risk of inflammation around the implant.Conclusion Peri-implantitis is a common disease that is related to smoking,residual cement around the implant,retraction of the mucosa around the implant,and a history of chronic periodontitis.The pathogenic bacteria causing infection were mainly anaerobic bacteria,and they were resistant to various antibacterials.A drug sensitivity test should be performed before treatment,and sensitive antibiotics should be used to consolidate the effectiveness of oral prosthodontics.