Adeyemo Wasiu Lanre, Adeyemi Michael O, Ogunsola Folasade T, Ogunlewe Mobolanle O, Ladeinde Akinola L, Mofikoya Bolaji O, Butali Azeez
Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, College of Medicine, University of Lagos, Lagos, Nigeria.
J Craniofac Surg. 2013 Jul;24(4):1126-31. doi: 10.1097/SCS.0b013e31828016e8.
The aim of the study was to determine the prevalence and bacteriology of bacteremia associated with cleft lip and palate (CLP) surgery. Three venous blood samples were obtained from 90 eligible subjects who presented for CLP surgery: before surgical incision, 1 minute after placement of the last suture, and 15 minutes thereafter. The samples were injected into an Oxoid Signal blood culture and transported to the laboratory for gram-positive/negative and aerobic/anaerobic bacteria analysis. Prevalence of bacteremia associated with cleft surgery was 38.1%. Prevalence rates of bacteremia in cleft lip surgery, cleft palate surgery, and alveoloplasty were 40.9%, 33.3%, and 50%, respectively. There was no significant difference in prevalence rate of positive blood culture in cleft lip surgery, cleft palate surgery, and alveoloplasty (P = 0.69). Positive blood culture was detected most frequently (47%) 1 minute after placement of the last suture. Of the 23 subjects who had positive blood culture at 1 minute, bacteremia persisted in 8 (35%) of them after 15 minutes. The most common bacteria isolated were coagulase-negative staphylococcus, Acinetobacter lwoffii, and coagulase-positive Staphylococcus aureus. Sex and age of the subjects, duration of surgery, blood loss, and type of cleft surgery were not significantly associated with positive blood culture. Bacteremia associated with CLP surgery is polymicrobial and persisted for at least 15 minutes after surgery in 35% of cases. This may reinforce the need for prophylactic antibiotics to protect at-risk patients from developing focal infection of the heart by oral flora.
本研究的目的是确定与唇腭裂（CLP）手术相关的菌血症的患病率及细菌学情况。从90名符合条件且前来接受CLP手术的受试者身上采集了三份静脉血样本：手术切口前、最后一针缝合后1分钟以及此后15分钟。将样本注入奥克托克斯信号血培养瓶中，并送至实验室进行革兰氏阳性/阴性菌及需氧/厌氧菌分析。与腭裂手术相关的菌血症患病率为38.1%。唇裂手术、腭裂手术和牙槽成形术中菌血症的患病率分别为40.9%、33.3%和50%。唇裂手术、腭裂手术和牙槽成形术中血培养阳性率无显著差异（P = 0.69）。血培养阳性最常出现在（47%）最后一针缝合后1分钟。在23名1分钟时血培养呈阳性的受试者中，15分钟后仍有8名（35%）存在菌血症。分离出的最常见细菌为凝固酶阴性葡萄球菌、鲁氏不动杆菌和凝固酶阳性金黄色葡萄球菌。受试者的性别、年龄、手术时长、失血量以及腭裂手术类型与血培养阳性无显著关联。与CLP手术相关的菌血症是多微生物性的，35%的病例中菌血症在术后至少持续15分钟。这可能进一步凸显了预防性使用抗生素以保护高危患者免受口腔菌群引起的心脏局灶性感染的必要性。
