Hartog B, Degener J E, Van Benthem P P, Hordijk G J
Eli Lilly Nederland B.V., Nieuwegein, The Netherlands.
Acta Otolaryngol. 1995 Sep;115(5):672-7. doi: 10.3109/00016489509139385.
In a comparative study on the efficacy of two surgical treatment procedures, 90 patients diagnosed with chronic maxillary sinusitis received antimicrobial prophylaxis. Maxillary sinus fluid samples were taken from these 90 patients before the initiation of antimicrobial prophylaxis, and were cultured for aerobic and anaerobic bacteria. In 81% of all samples, bacterial growth was present. Anaerobic bacteria were present in 29% of the cases (5% pure anaerobic and 24% mixed aerobic and anaerobic). Predominant aerobic bacteria were staphylococci, in 42% of all samples (mainly coagulase-negative), and streptococci (32%). Predominant anaerobic bacteria were Propionibacterium species (18%) and Gram-negative rods (9%). The antimicrobial susceptibility was determined for 20 antibiotics, and the beta-lactamase production was investigated. The prevalence of beta-lactamase-producing bacteria was unexpectedly high (isolated from 36% of all patients). The findings in this study indicate that not all antimicrobial agents used against upper respiratory tract infections are suitable for treatment of this group of patients when the susceptibility of bacteria present in sinus fluid is taken into account. The high prevalence of beta-lactamase-producing bacteria could influence the course of the disease, due to the breakdown of antibiotics by such strains. Recommendations are given for criteria to use when choosing antimicrobial agents to treat bacterial infections it) patients with chronic maxillary sinusitis.
在一项关于两种外科治疗方法疗效的对比研究中，90例被诊断为慢性上颌窦炎的患者接受了抗菌预防。在开始抗菌预防之前，从这90例患者中采集上颌窦液样本，并对需氧菌和厌氧菌进行培养。在所有样本中，81%出现了细菌生长。29%的病例中存在厌氧菌（5%为纯厌氧菌，24%为需氧菌和厌氧菌混合感染）。主要的需氧菌是葡萄球菌，在所有样本中占42%（主要是凝固酶阴性菌），链球菌占32%。主要的厌氧菌是丙酸杆菌属（18%）和革兰氏阴性杆菌（9%）。测定了20种抗生素的抗菌敏感性，并研究了β-内酰胺酶的产生情况。产β-内酰胺酶细菌的患病率出人意料地高（从所有患者的36%中分离得到）。本研究结果表明，考虑到窦液中存在的细菌的敏感性时，并非所有用于治疗上呼吸道感染的抗菌药物都适用于治疗这类患者。由于这类菌株会破坏抗生素，产β-内酰胺酶细菌的高患病率可能会影响疾病的进程。文中给出了在选择抗菌药物治疗慢性上颌窦炎患者细菌感染时应使用的标准建议。
