University Hospital for Cranio-Maxillofacial and Oral Surgery, Medical University Vienna, Vienna, Austria.
J Endod. 2011 Sep;37(9):1201-5. doi: 10.1016/j.joen.2011.05.029. Epub 2011 Jul 16.
The aims of the present study were to compare microbial populations in patients suffering from deep neck space abscesses caused by primary endodontic infections by sampling the infections with aspiration or swabbing techniques and to determine the susceptibility rates of the isolated bacteria to commonly used antibiotics.
A total of 89 patients with deep neck space abscesses caused by primary endodontic infections requiring extraoral incision and drainage under general anesthesia were included. Either aspiration or swabbing was used to sample microbial pus specimens. The culture of the microbial specimens and susceptibility testing were performed following standard procedures.
A total of 142 strains were recovered from 76 patients. In 13 patients, no bacteria were found. The predominant bacteria observed were streptococci (36%), staphylococci (13%), Prevotella (8%), and Peptostreptococcus (6%). A statistically significant greater number of obligate anaerobes were found in the aspiration group. The majority of patients presented a mixed aerobic-anaerobic population of bacterial flora (62%). The antibiotic resistance rates for the predominant bacteria were 10% for penicillin G, 9% for amoxicillin, 0% for amoxicillin clavulanate, 24% for clindamycin, and 24% for erythromycin.
The results of our study indicated that a greater number of anaerobes were found when sampling using the aspiration technique. Penicillin G and aminopenicillins alone are not always sufficient for the treatment of severe deep neck space abscesses; beta-lactamase inhibitor combinations are more effective. Bacteria showed significant resistant rates to clindamycin. Thus, its single use in penicillin-allergic patients has to be carefully considered.
本研究的目的是通过抽吸或拭子技术从原发性牙髓感染引起的深部颈间隙脓肿患者中取样，比较微生物种群，并确定分离细菌对常用抗生素的敏感性。
共纳入 89 例因原发性牙髓感染需全身麻醉下经口外切开引流的深部颈间隙脓肿患者。采用抽吸或拭子法采集微生物脓液标本。按照标准程序进行微生物标本的培养和药敏试验。
从 76 例患者中共分离出 142 株菌。在 13 例患者中未发现细菌。主要观察到链球菌（36%）、葡萄球菌（13%）、普雷沃菌（8%）和消化链球菌（6%）。抽吸组中发现的需氧厌氧菌数量明显较多。大多数患者表现出混合需氧-厌氧菌群（62%）。主要细菌的抗生素耐药率分别为青霉素 G 10%、阿莫西林 9%、阿莫西林克拉维酸 0%、克林霉素 24%和红霉素 24%。
我们的研究结果表明，抽吸技术采样时发现的厌氧菌数量更多。青霉素 G 和氨青霉素单独使用治疗严重深部颈间隙脓肿并不总是足够的；β-内酰胺酶抑制剂联合用药更有效。细菌对克林霉素表现出显著的耐药率。因此，在青霉素过敏患者中单独使用时需谨慎考虑。
