重症口腔颌面部间隙感染病原菌分布及危险因素调查  

Analysis of pathogenic bacteria distribution and risk factors of severe oral and maxillofacial space infections

作　　者：沈锂[1] 杨晶[1] 王伟峰[1] 青松[1] SHEN Li;YANG Jing;WANG Weifeng;QING Song(Affiliated hospital of north sichuan medical college,Nanchong 637000,Sichuan,China)

机构地区：[1]川北医学院附属医院,四川南充637000

出　　处：《中国病原生物学杂志》2024年第12期1469-1473,共5页Journal of Pathogen Biology

摘　　要：目的 探析重症口腔颌面部间隙感染患者病原菌分布特点及相关危险因素。方法 选取本院治疗的77例重症口腔颌面部感染患者及同期收治的未发生间隙感染的70例口腔颌面外科患者为研究对象。收集患者资料,分析感染相关危险因素。患者入院次日,采集患者感染部位脓液的分泌物进行病原菌培养鉴定及药敏试验。结果 77例感染患者中,52例为牙源性感染,14例为腺源性感染,8例为外伤性感染,3例为医源性感染。84.42%为单间隙感染,其中23.38%为眶下间隙,15.58%为咬肌间隙,14.29%为颊间隙,10.39%为颌下间隙,6.49%为舌下间隙,5.19%为翼颌间隙,3.90%为咽旁间隙,2.60%为颏下间隙,2.60%为颞下间隙。15.58%为多间隙感染,其中9.09%为咬肌+翼颌间隙,3.90%为眶下+颞下间隙,2.60%为颌下+舌下间隙。牙源性感染、腺源性感染患者主要为单间隙感染,以眶下间隙、咬肌间隙为主,外伤性感染患者主要以颌下间隙、咽旁间隙为主,医源性感染均为单间隙感染。共检出病原菌105株,革兰阳性菌共58株,革兰阴性菌共42株,真菌共5株。革兰阳性菌主要包括金黄色葡萄球菌(15.24%,16/105)和草绿色链球菌(14.29%,15/105)。革兰阴性菌主要包括肺炎克雷伯菌(13.33%,14/105)和铜绿假单胞菌(8.57%,9/105)。真菌主要为白色假丝酵母菌(3.81%,4/105)。金黄色葡萄球菌对氨苄西林、青霉素、红霉素、克林霉素的耐药率高于50%,未产生对替加环素、万古霉素的耐药株。肺炎克雷伯菌对氨苄西林、氨曲南的耐药率高于50%,对妥布霉素、头孢吡肟、环丙沙星、亚胺培南的耐药率低于30%,未产生对阿米卡星的耐药株。感染组与对照组患者临床资料对比显示,性别、体重指数差异无统计学意义(P>0.05),年龄、入院体温、吸烟史、糖尿病、使用糖皮质激素、医源性操作不当差异有统计学意义(P<0.05)。年龄≥65岁、有吸烟史、医源性操作不当是�Objective The distribution characteristics of pathogenic bacteria and related risk factors in patients with severe oral and maxillofacial space infections were analyzed.Methods 77 patients with severe oral and maxillofacial infections who were treated in our hospital and 70 inpatients in the oral and maxillofacial surgery department who did not have severe oral and maxillofacial space infections during the same period were selected as the research subjects.The relevant data of the patients were collected,and the related risk factors of infections were analyzed.On the second day after admission,the secretions of pus from the infected sites of the patients were collected for pathogen culture and identification and drug sensitivity test.ResultsAmong the 77 patients with infections,52 cases were odontogenic infections,l4 cases were adenogenic infections,8 cases were traumatic infections,and 3 cases were iatrogenic infections.84.42%were single-space infections,of which 23.38%were infraorbital space,15.58%were masseteric space,14.29%were buccal space,10.39%were submandibular space,6.49%were sublingual space,5.19%were pterygomandibular space,3.90%were parapharyngeal space,2.60%were submental space,and 2.60%were infratemporal space.15.58%were multi-space infections,of which 9.09%were masseteric+pterygomandibular space,3.90%were infraorbital+infratemporal space,and 2.60%were submandibular+sublingual space.Odontogenic and adenogenic infection patients were mainly single-space infections,mainly in the infraorbital space and masseteric space.Traumatic infection patients were mainly in the submandibular space and parapharyngeal space.Iatrogenic infections were all single-space infections.A total of 105 pathogenic bacteria were detected,including 58 Gram-positive bacteria,42 Gram-negative bacteria and 5 fungi.The main Gram-positive bacteria included Staphylococcus aureus(15.24%,16/105)and Streptococcus viridans(14.29%,15/105).The main Gram-negative bacteria included Klebsiella pneumoniae(13.33%,14/105)and Pseudomonas aeruginos

关 键 词：口腔颌面部间隙感染 病原菌 危险因素 

分 类 号：R446.5[医药卫生—诊断学] R782.3[医药卫生—临床医学]