口腔颌面部间隙感染病原学特点、炎症因子及相关因素探讨

目的探讨口腔颌面部间隙感染的病原学特点及炎症因子水平,并分析感染相关因素。方法上海市松江区中心医院2016年5月-2017年12月口腔科收治的口腔疾病患者668例,分为感染组(n=61)和未感染组(n=607),检测并比较两组患者炎症因子水平。取患者口腔颌面部间隙感染分泌物进行病原菌的培养、鉴定及药敏试验,分析其感染的相关危险因素。结果感染组PCT、CRP、WBC、NEU分别为(5.53±0.76)μg/L、(33.74±3.97) mg/L、(13.26±1.42)×10^9/L和(86.78±8.39)%,未感染组分别为(0.42±0.08)μg/L、(23.19±2.45)mg/L、(10.53±1.21)×10^9/L和(71.26±7.65)%,差异均有统计学意义(均P<0.05)。61例口腔颌面部间隙感染患者共检出病原菌78株,以需氧和需氧-厌氧菌为主。需氧菌主要包括金黄色葡萄球菌、溶血葡萄球菌(10.26%)和肺炎链球菌(8.97%),需氧-厌氧菌以草绿色链球菌(16.67%)和普氏菌(11.53%)为主。金黄色葡萄球菌、溶血葡萄球菌和肺炎链球菌对青霉素G,氨苄西林及氨曲南耐药率为57.14%~100.00%,对利福平和亚胺培南的耐药率为12.50%~28.75%。草绿色链球菌、普氏菌与梭杆菌对红霉素和青霉素G耐药率33.33%~100.00%,对甲硝唑和亚胺培南耐药率为0~15.38%。感染的发生与年龄≥65岁、白细胞≥15×10^9 mg/L、糖尿病、入院体温高于38℃、医源性操作不当、住院天数及自我治疗有关(P<0.05)。其中年龄≥65岁、白细胞≥15×10^9 mg/L、自我治疗和医源性操作不当均为感染的独立危险因素。结论口腔颌面部间隙感染患者病原菌类型多样,耐药情况严重,且需关注年龄≥65岁、白细胞≥15×10^9 mg/L、自我治疗和医源性操作不当的患者,减少口腔颌面部间隙感染的发生。

Pathogenic characteristics,inflammatory factors and related factors in oral and maxillofacial space infection

Objective To examine pathogenic characteristics and inflammatory factors in oral and maxillofacial space infections and to analyze related factors. Methods Clinical data on 668 patients with an oral condition seen at Shanghai Songjiang District Central Hospital from May 2016 to December 2017 were collected. Patients were divided into those with an infection(n=61) and those without an infection(n=607). The levels of inflammatory factors were compared between the two groups. The oral and maxillofacial space infection and secretion were taken for pathogen culture, identification, and drug susceptibility testing, and risk factors related to infection were analyzed. Results The PCT level in patients with an infection was 5.53±0.76 μg/L, the CRP level was 33.74±3.97 mg/L, the WBC count was 13.26±1.42×10^9/L, and the percentage of NEU was 86.78±8.39%. The PCT level in patients without an infection was 0.42±0.08 μ g/L, the CRP level was 23.19±2.45 mg/L, the WBC count was 10.53±1.21×10^9/L, and the percentage of NEU was 71.26±7.65%. Those parameters differed significantly between the 2 groups(P<0.05). A total of 78 pathogenic bacteria were detected in 61 patients with an oral and maxillofacial space infection, and those bacteria were mainly aerobic and aerobic-anaerobic bacteria. Aerobic bacteria mainly included Staphylococcus aureus, S. haemolyticus(10.26%), and Streptococcus pneumoniae(8.97%). Aerobic-anaerobic bacteria were mainly S. mutans(16.67%) and Prionella(11.53%). S. aureus, S. haemolyticus, and S. pneumoniae were resistant to penicillin G at rates of 100.00%, 87.50%, and 100.00%, to ampicillin at rates of 78.57%, 75.00%, and 85.71%, to aztreonam at rates of 57.14%, 62.50%, and 57.14%, to rifampicin at rates of 28.57%, 25.00%, and 14.29%, and to imipenem at rates of 14.28%, 12.50%, and 14.29%. S. viridis, S. pullulans, and Clostridium were resistant to erythromycin and penicillin G at rates of 100.00%, 37.50%, and 33.33%, to metronidazole at rates of 15.38%, 0.00%, and 0.00%, and to imipenem at rates of 0.00%, 0.00%, and 0.00%. Infection was associated with age(>65 years), a high white blood cell count(>15×10^9 mg/L), diabetes mellitus, a temperature higher than 38℃, the number of days in hospital and multi-gap infection with self-treatment(P<0.05). Age≥ 65 years, white blood cells ≥ 15×10^9 mg/L, self-treatment, and improper procedure are independent risk factors for infection. Conclusion Various pathogens were found in patients with oral and maxillofacial space infections are, and they are highly drug-resistant. More attention should be paid to patients age 65 or older, with a white blood cell count of 15×10^9 mg/L or higher, engaging in self-treatment, or suffering an improper procedure in order to reduce the rate of infection.