Kim Min Kyoung, Chuang Sung-Kiang, August Meredith
Student, Harvard School of Dental Medicine, Boston, MA.
Private Practitioner, Brockton, MA.
J Oral Maxillofac Surg. 2017 May;75(5):962-968. doi: 10.1016/j.joms.2016.10.039. Epub 2016 Nov 9.
This study assessed the antibiotic resistance profile in patients with severe orofacial infections treated at a single institution from 2009 through 2014. Factors contributing to resistance were studied. The resistance profile was compared with that of a cohort of similar patients treated a decade previously to identify changes in antibiotic resistance. In addition, the effect of antibiotic resistance on in-hospital course was studied.
This was a 5-year retrospective cohort study. Patients were identified through the oral and maxillofacial surgery data registry. Inclusion criteria were patients treated for orofacial infection requiring hospital admission, surgical drainage, and availability of complete medical, surgical, and microbiological data. Patients with incomplete data or treated as outpatients or nonsurgically were excluded. Sixty patient charts were identified for review. Demographic data; medical, dental, and surgical histories; and hospital course and treatment specifics were obtained for each patient. Linear regression and logistic analyses were used to analyze the data.
Men composed 60% of the cohort (mean age, 45 yr). Average hospital stay was 5.5 days. Penicillin resistance was found in 32.5% of aerobic isolates and clindamycin resistance was found in 29.3%. Streptococcus viridans and Staphylococcus species showed increased resistance to clindamycin and erythromycin compared with historic controls. Younger patient age, surgical history, and number of cultured aerobes showed a relevant correlation to antibiotic resistance. The need for changes in antibiotics, repeat surgical drainage, and increased serum urea nitrogen levels correlated with longer hospital stay.
A serious increase in clindamycin and erythromycin resistance was found for S viridans and Staphylococcus species. Age, surgical history, and number of cultured aerobes showed a statistically meaningful correlation to antibiotic resistance. Presence of antibiotic resistance failed to show statistically relevant correlations to prolongation of hospital stay. Rather, the need for change in antibiotic regimen, the need for re-drainage, and increased serum urea nitrogen level were associated with longer hospital stay.
本研究评估了2009年至2014年在单一机构接受治疗的严重口腔颌面部感染患者的抗生素耐药情况。研究了导致耐药的因素。将耐药情况与十年前治疗的一组类似患者的情况进行比较，以确定抗生素耐药性的变化。此外，还研究了抗生素耐药性对住院病程的影响。
这是一项为期5年的回顾性队列研究。通过口腔颌面外科数据登记系统识别患者。纳入标准为因口腔颌面部感染接受治疗、需要住院、手术引流且有完整的医学、外科和微生物学数据的患者。排除数据不完整或作为门诊患者治疗或非手术治疗的患者。确定了60份患者病历进行审查。获取了每位患者的人口统计学数据、医学、牙科和手术史以及住院病程和治疗细节。使用线性回归和逻辑分析对数据进行分析。
该队列中男性占60%（平均年龄45岁）。平均住院时间为5.5天。在32.5%的需氧菌分离株中发现青霉素耐药，在29.3%的分离株中发现克林霉素耐药。与历史对照相比，草绿色链球菌和葡萄球菌属对克林霉素和红霉素的耐药性增加。患者年龄较小、手术史以及培养的需氧菌数量与抗生素耐药性呈显著相关性。更换抗生素的需求、重复手术引流以及血清尿素氮水平升高与住院时间延长相关。
发现草绿色链球菌和葡萄球菌属对克林霉素和红霉素的耐药性严重增加。年龄、手术史和培养的需氧菌数量与抗生素耐药性呈统计学意义上的相关性。抗生素耐药性的存在与住院时间延长未显示出统计学上的显著相关性。相反，抗生素治疗方案的改变需求、再次引流的需求以及血清尿素氮水平升高与住院时间延长相关。
