颌面部感染的病原菌及耐药性

Pathogens and antimicrobial resistance in maxillofacial infection

摘要:

目的了解颌面部感染患者病原菌分布及其药物敏感性，为临床合理使用抗菌药物提供依据。方法收集2012年1月—2016年12月某医院口腔颌面部感染患者标本进行病原菌培养，对病原菌进行鉴定和药敏检测，分析病原菌分布及耐药性。结果882例颌面部感染患者中男性占32.20%，女性占67.80%；年龄为～40岁、～60岁组的患者较多，分别占35.38%和32.65%；共分离病原菌145株，革兰阴性菌88株，占60.69%，以肺炎克雷伯菌和铜绿假单胞菌为主；革兰阳性菌56株，占38.62%，以金黄色葡萄球菌为主。肺炎克雷伯菌对检测的16种药物的耐药率均<50%，对亚胺培南和美罗培南的耐药率最低，均为3.45%，11株为产超广谱β 内酰胺酶（ESBLs）阳性菌株；铜绿假单胞菌对检测的10种药物耐药率均<40%。金黄色葡萄球菌对替加环素、利奈唑胺、万古霉素均敏感，对青霉素的耐药率最高（66.67%），对苯唑西林的耐药率为20.83%。结论口腔颌面部感染病原菌以革兰阴性菌为主，不同病原菌耐药性差别较大，在临床治疗时，应根据药敏结果合理使用抗菌药物。

Abstract:

ObjectiveTo investigate the distribution and antimicrobial susceptibility of pathogens causing maxillofacial infection in patients, and provide evidence for rational use of antimicrobial agents in clinical practice. MethodsSpecimens of patients infected with oral and maxillofacial infection in a hospital between January 2012 and December 2016 were performed microbial culture, pathogens were identified and performed antimicrobial susceptibility testing, distribution of pathogens and antimicrobial resistance were analyzed. ResultsOf 882 patients with maxillofacial infection, male and female accounted for 32.20% and 67.80% respectively; 35.38% and 32.65% of patients aged ～40 years and ～60 years respectively; a total of 145 strains were isolated, 88(60.69%) of which were gramnegative bacteria, mainly Klebsiella pneumoniae and Pseudomonas aeruginosa; 56(38.62%) of which were grampositive bacteria, mainly Staphylococcus aureus. Resistance rates of Klebsiella pneumoniae to 16 kinds of antimicrobial agents were all<50%，resistance rates to imipenem and meropenem were the lowest, both were 3.45%, 11 strains were extendedspectrum βlactamasesproducing strains; resistance rates of Pseudomonas aeruginosa to 10 kinds of antimicrobial agents were all<40%. Staphylococcus aureus was susceptible to tigecycline, linezolid, and vancomycin, resistance rate to penicillin was the highest（66.67%），resistance rate to oxacillin was 20.83%. ConclusionThe main pathogens causing oral and maxillofacial infection are gramnegative bacteria, different pathogens have different antimicrobial resistance, antimicrobial agents should be used rationally during clinical treatment according to antimicrobial susceptibility testing result.