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Weichteilinfektionen in der Mund-, Kiefer- und Plastischen Gesichtschirurgie

Keimspektren und Antibiotika

Soft tissue infections in oral, maxillofacial, and plastic surgery

Bacterial spectra and antibiotics

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Zusammenfassung

Hintergrund

Die bei Weichteilinfektionen in der Mund-, Kiefer und Plastischen Gesichtschirurgie zu erwartenden Keimspektren umfassen neben Staphylococcus aureus, Pseudomonas aeruginosa sowie Escherichia coli auch die Erregergattungen Enterococcus, Klebsiella und Enterobacter.

Methode

Die vorliegende prospektive Studie erfasst die aktuellen Keimspektren und die Resistenzquoten gegenüber in der Mund-, Kiefer- und Plastischen Gesichtschirurgie etablierten Antibiotika bei 96 Patienten mit nichtodontogenen postoperativen Weichteilinfektionen.

Ergebnisse

Die dominierenden Erregergattungen waren Streptococcus (25% der Isolate), Staphylococcus (24% der Isolate) und Vertreter der Familie der Enterobacteriaceae (10% der Isolate). Bei Wundinfektionen mit enoraler Eintrittspforte fanden sich zusätzlich Anaerobier (Peptostreptococcus, Eubacterium, Prevotella und Fusobacterium). Es zeigten sich folgende Resistenzquoten: Penicillin G und Doxycyclin jeweils 36%, Ampicillin 42%. Gegen Erythromycin und Clindamycin waren 26% bzw. 7% der getesteten Erreger resistent. Keine resistenten Stämme fanden sich bei Vancomycin und Teicoplanin. Im anaeroben Bereich allein bestätigte sich die aus regionaler Sicht bekannte hohe antimikrobielle Wirksamkeit von Penicillinen wie auch die der meisten anderen gängigen Antibiotika.

Schlussfolgerung

Das im Gegensatz zu den odontogenen Infektionen völlig andere Keimspektrum mit entsprechend veränderter antibiotischer Effektivität sollte nach Möglichkeit gezielt nach Erregeranzucht und Differenzierung antibiotisch behandelt werden. Als Antibiotika der Wahl empfehlen sich neben Imipenem und Meropenem auch Ciprofloxacin und Cefotiam. Mögliche Alternativen sind in der Zukunft mit Sicherheit in Form der neuen Generation der Fluorchinolone zu sehen.

Abstract

Background

Soft tissue infections in the maxillofacial region are mainly caused by Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli but also by members of the genera Enterococcus, Klebsiella, and Enterobacter, respectively.

Methods

In a prospective study 96 patients with severe maxillofacial non-odontogenic postoperative soft tissue infections were analyzed with regard to the bacterial spectrum and resistance patterns against antibiotics. The dominating bacteria were Streptococci (25% of the isolates) and Staphylococci (24% of the isolates). In addition, members of Enterobacteriaceae were isolated in approximately 10% of the cases. The most frequent anaerobes found were as follows: Peptostreptococcus, Eubacterium, Prevotella and Fusobacterium.

Results

The resistance rates against antibiotics found were: penicillin G 36%, ampicillin 42%, and doxycycline 36%. In addition, the resistance rate against erythromycin and clindamycin was 26% and 7%, respectively. No resistant strains were detected against vancomycin and teicoplanin. All anaerobes showed a low antimicrobial resistance as previously described for odontogenic infections.

Conclusion

In summary, soft tissue infections in the maxillofacial region present a different spectrum of bacteria in contrast to the well-investigated odontogenic infections. Antibiotic administration should be, whenever possible, performed after differentiation of involved strains and resistogram. The most promising antibiotics are imipenem, meropenem, and ciprofloxacin as well as cefotiam. Modern fluoroquinolones will be the antibiotics of the future.

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Authors and Affiliations

  1. Universitäts-Klinik und Poliklinik für Mund-, Kiefer- und Plastische Gesichtschirurgie, Martin-Luther-Universität Halle-Wittenberg

    A. W. Eckert, P. Maurer & J. Schubert

  2. Institut für Medizinische Mikrobiologie, Martin-Luther-Universität Halle-Wittenberg

    D. Wilhelms

  3. Universitäts-Klinik und Poliklinik für Mund- Kiefer- und Plastische Gesichtschirurgie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle/Saale

    A. W. Eckert

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  2. P. Maurer
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  3. D. Wilhelms
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  4. J. Schubert
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Correspondence to A. W. Eckert.

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Eckert, A.W., Maurer, P., Wilhelms, D. et al. Weichteilinfektionen in der Mund-, Kiefer- und Plastischen Gesichtschirurgie. Mund Kiefer GesichtsChir 9, 389–395 (2005). https://doi.org/10.1007/s10006-005-0645-1

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