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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 investigate the distribution and drug sensitivity analysis of anaerobes in patients with oral and maxillofacial infection and provide evidence for the selection of clinical antimicrobial agents. Methods 55 patients with oral and maxillofacial infection were selected as the research objects. The pus samples of oral and maxillofacial infection were collected simultaneously with aerobic and anaerobic culture. The pure bacteria were cultured in API20A biochemical reaction plate Company) for anaerobic bacteria identification, and the use of Etest method (French biomedical company) drug sensitivity test to determine the types of pathogens and anaerobic resistance. Results In all 55 cases of oral and maxillofacial infection, 44 cases (80.00%) were infected with mixed bacteria from anaerobic bacteria and aerobic bacteria, 49 cases (89.09%) with anaerobic bacteria infection, 5 cases (9.09%), simple aerobic bacteria infection in 6 cases (10.91%). In this study, 72 anaerobic bacteria were isolated, of which 32 (44.44%) were gram-positive anaerobes and 40 (55.56%) were gram-negative anaerobes. Gram-positive anaerobic bacteria isolated the highest rate of Peptostreptococcus (34.72%); Gram-negative anaerobic bacteria in the highest separation rate of Porphyromonas (37.50%), Prevotella 13.89%). The results of drug sensitivity showed that the resistant rate of Clindamycin to Peptostreptococcus was the highest (48.00%), and one strain was resistant to metronidazole. Porphyromonas and Prevotella belonged to clindamycin And penicillin (> 50%). No strains resistant to amoxicillin / clavulanic acid and cefoxitin were found in Gram-positive and -negative anaerobes. Conclusion Oral and maxillofacial infections are usually aerobic and anaerobic mixed pathogens, of which anaerobic bacteria occupy a higher proportion of Gram-negative anaerobic bacteria than gram-positive anaerobes. The strains were highly sensitive to metronidazole, amoxicillin / clavulanic acid and cefoxitin, higher resistance rate to clindamycin; penicillin was more active against Gram-positive anaerobic bacteria, Less active.