Pigrau C, Almirante B, Rodriguez D, Larrosa N, Bescos S, Raspall G, Pahissa A
Hospital Universitari Vall D'Hebron, Universitat Autonoma, Barcelona, Spain.
Eur J Clin Microbiol Infect Dis. 2009 Apr;28(4):317-23. doi: 10.1007/s10096-008-0626-z. Epub 2008 Sep 17.
The purpose of this paper was to review our clinical experience in patients with osteomyelitis (OM) of the jaw, focusing on aspects of antimicrobial resistance. A retrospective review of the medical records of adult patients with jaw OM was carried out. Among 46 cases of jaw OM, the cause was odontogenic in 32 (seven had recent dental implants and four bisphosphonate osteonecrosis), postoperative/post-traumatic in eight, and secondary to osteoradionecrosis in six. Clinical features were chronic in 91.3%. The infection was polymicrobial in 24/41 (65.9%). Viridans streptococci were the most commonly isolated agents. Among 26 viridans streptococci tested, 81% were susceptible to penicillin and 96% to fluorquinolones, but only 11.5% to clindamycin. Overall, 35/38 (92.1%) had at least one clindamycin-resistant isolate. Appropriate antibiotics were administered for a mean of 5.8 +/- 3.2 months. Beta-lactams were used in 19 cases and fluorquinolones in 14. Among 39 cases with long-term follow-up, only two relapsed. Currently, jaw OM is commonly related to osteoradionecrosis, dental implants, and bisphosphonates. In patients with prior antibiotics exposure, a high percentage of infections were caused by clindamycin-resistant microorganisms, thus, beta-lactams should be the antibiotic of choice. In penicillin-allergic cases, the new fluorquinolones, probably in combination with rifampin and/or clindamycin, could be a promising alternative.
本文旨在回顾我们在颌骨骨髓炎（OM）患者中的临床经验，重点关注抗菌药物耐药性方面。对成年颌骨OM患者的病历进行了回顾性研究。在46例颌骨OM病例中，病因是牙源性的有32例（7例近期有牙种植体，4例为双膦酸盐性骨坏死），术后/创伤后8例，继发于放射性骨坏死6例。91.3%的临床特征为慢性。41例中有24例（65.9%）感染为多微生物感染。草绿色链球菌是最常见的分离菌。在检测的26株草绿色链球菌中，81%对青霉素敏感，96%对氟喹诺酮类敏感，但仅11.5%对克林霉素敏感。总体而言，38例中有35例（92.1%）至少有一株对克林霉素耐药的分离菌。适当使用抗生素的平均时间为5.8±3.2个月。19例使用了β-内酰胺类抗生素，14例使用了氟喹诺酮类抗生素。在39例长期随访的病例中，仅2例复发。目前，颌骨OM通常与放射性骨坏死、牙种植体和双膦酸盐有关。在先前接触过抗生素的患者中，高比例的感染是由对克林霉素耐药的微生物引起的，因此，β-内酰胺类抗生素应作为首选抗生素。在对青霉素过敏的病例中，新型氟喹诺酮类抗生素，可能与利福平或/和克林霉素联合使用，可能是一种有前景的替代方案。
