口腔颌面部感染患者厌氧菌分布及药敏试验结果分析  

Distribution and antimicrobial susceptibilities of anaerobic bacteria isolated from patients with oral and maxillofacial infections

作　　者：包振英[1] 王瑶[2] 谢秀丽[2] 彭歆[1] 孟彦宏 齐小梅[1] 

机构地区：[1]北京大学口腔医院,北京100081 [2]北京协和医院

出　　处：《中国预防医学杂志》2016年第2期143-147,共5页Chinese Preventive Medicine

摘　　要：目的探讨口腔颌面部感染患者厌氧菌分布及药敏分析,为临床抗菌药物的选择提供依据。方法以55例口腔颌面部感染患者为研究对象,取患者口腔颌面部感染部位的脓液样本同时进行需氧菌、厌氧菌培养,取纯菌采用API20A生化反应板(法国生物梅里埃公司)进行厌氧菌鉴定,并采用Etest方法 (法国生物梅里埃公司)进行药物敏感试验,确定病原菌类型及厌氧菌耐药情况。结果 55例口腔颌面部感染患者的脓液样本全部分离出细菌,厌氧菌和需氧菌混合感染44例(80.00%);厌氧菌感染49例(89.09%);单纯厌氧菌感染5例(9.09%),单纯需氧菌感染6例(10.91%)。本研究共分离出72株厌氧菌,其中革兰阳性厌氧菌32株(44.44%),革兰阴性厌氧菌40株(55.56%)。革兰阳性厌氧菌中分离率最高的是消化链球菌(34.72%);革兰阴性厌氧菌中分离率最高的依次为卟啉单胞菌属(37.50%)、普雷沃菌属(13.89%)。药敏结果显示:消化链球菌对克林霉素耐药率最高(48.00%),出现1株对甲硝唑耐药菌株;卟啉单胞菌属和普雷沃菌属对克林霉素和青霉素耐药率较高(>50%),革兰阳性和阴性厌氧菌均未出现对阿莫西林/克拉维酸和头孢西丁耐药的菌株。结论口腔颌面部感染通常为需氧、厌氧混合性病原菌感染,其中厌氧菌占有较高比例,革兰阴性厌氧菌检出率高于革兰阳性厌氧菌。菌株对甲硝唑、阿莫西林/克拉维酸和头孢西丁高度敏感,对克林霉素耐药率较高;青霉素对革兰阳性厌氧菌活性强,而对革兰阴性厌氧菌活性较低。Objective To discuss the distribution and antimicrobial susceptibilities of anaerobes isolated from patients with oral and maxillofacial infections, and provide evidence-based data for empiricalantimierobial ther- apy. Methods Pus specimens were collected from fifty-five patients with oral and maxillofacial infec- tions. Both aerobic and anaerobic cultures were conducted for all specimens. All the anaerobic bacteria were i- dentified by API20A strip （Bio M6rieux, France）. Antimierobial susceptibilities were determined by E-test （Bio M6rieux, France）. Results Bacteria were isolated from pus specimens of all 55 patients with oral and maxillofacial infections. Forty-four cases （80. 00%） had mixed infections of anaerobes and aerobes. Forty-nine patients （89.09%） were infected with anaerobes. Five （9.09%） and 6 （10. 91%） patients were infected with only anaerobes or aerobes. A total of 72 strains of anaerobes were isolated, including 32 strains （44.44%） of gram-positive and 40 （55.56~） strains of gram-negative anaerobes. Peptostreptococcus spp. was the most common isolated gram-positive anaerobe （34.72%） . Porphyromonas spp. （37.50%） and Prevotella spp. （13.890% ） were the top two isolated gram-negative anaerobes. Antimicrobial susceptibility test revealed that Pep- tostreptococcus spp. was highly resistant to clindamycin （48.00%） and there was one strain resistant to metron- idazole. Both Porphyromonas spp. and Prevotella spp. were highly resistant to clindamycin and penicillin （〉50 %）. All the anaerobes were susceptible to amoxicillin/clavulanate and cefoxitin. Conclusions Oral and maxillofacial infections are usually mixed with both aerobes and anaerobes, in which anaerobes are predominant. The isola- ting rate of gram-negative anaerobe is higher than that of gram-positive anaerobe. In this study, anaerobes are highly susceptible to metronidazole, amoxiciIlin/elavulanate and cefoxitin, while highly resistant to clindamy- ein. Penicillin is very effective in kill

关 键 词：口腔颌面部感染 厌氧菌 分布 抗生素敏感性 

分 类 号：R446.5[医药卫生—诊断学]