开胸术后切口感染合并肋软骨炎的综合治疗

目的：探讨开胸术后切口感染合并肋软骨炎的治疗方法。方法：2011年1月至2014年1月我院收治的166例开胸术后切口感染、不愈的患者,其中35例患者合并肋软骨炎,男26例,女9例,年龄35～79岁,平均年龄（58.9±15.0）岁,术前采用分泌物细菌培养+药敏、清创、封闭负压引流;术中彻底清创、去除受累肋软骨、钢丝取出、双侧胸大肌转移修复;术后引流、应用敏感抗生素等综合治疗,封闭创面。结果：35例患者术后3～15d拔除引流管,27例患者创面术后10～15d后一期愈合;1例患者形成肌瓣下窦道,经换药后创面愈合;4例患者行二次手术清创后创面愈合,其中1例患者为出院后6个月复发,再次入院手术清创后3周创面愈合;3例患者行三次手术清创后创面愈合。35例患者术后均随访6个月～2年,创面愈合良好。结论：采用术前清创、封闭负压引流、术中彻底清创、去除受累肋软骨、钢丝取出、双侧胸大肌转移、围手术期应用敏感抗生素等综合治疗是修复开胸术后切口感染合并肋软骨炎的一种有效方法,取得了良好的临床疗效。     

Systemic antimicrobials in the treatment of chronic periodontal diseases: a dilemma

The use of systemic antimicrobials in the treatment of acute and chronic periodontal diseases must be viewed as a dilemma. On the one hand, the approach is attractive because of the microbial nature of periodontal diseases but, on the other hand, evidence of benefit of these agents is equivocal for the majority of periodontal diseases and antimicrobials have the potential to cause harm. The disadvantages of systemic antimicrobials can be grouped under the headings of allergic reactions, superinfection, toxicity, drug interactions, patient compliance and, perhaps of most widespread importance, bacterial resistance. Mechanical debridement methods, including drainage of pus for acute periodontal abscesses, should be considered the first line treatment for most periodontal diseases. Systemic antimicrobials should be considered as adjuncts to mechanical debridement methods and, in chronic disease, never used alone as they can predispose to abscess formation. Adjunctive systemic antimicrobials may be considered in acute disease where debridement or drainage of pus is difficult, where there is local spread or systemic upset. In chronic periodontal diseases, adjunctive antimicrobials should be considered in early onset or rapidly progressive disease or in advanced chronic adult disease where mechanical therapies have failed or surgery is not a preferred option. Inadequate oral hygiene and tobacco smoking are contra-indications to the use of antimicrobials. The value of systemic antimicrobials, where other systemic risk factors co-exist, has still to be established. The role of microbial diagnosis and sensitivity testing for antimicrobial selection at this time must be questioned.     

Antibiotic resistance of subgingival species during and after antibiotic therapy

AIM: The purpose of the present investigation was to determine the percentage and identity of antibiotic-resistant species in subgingival plaque and saliva samples from chronic periodontitis patients treated by scaling and root planing followed by orally administered amoxicillin or metronidazole. METHOD: In all, 20 chronic periodontitis patients were selected for study. After clinical and microbiological monitoring, subjects were randomly assigned to receive either orally administered amoxicillin at the dosage of 500 mg, 3 times daily for 14 days or orally administered metronidazole at the dosage of 250 mg, 3 times daily for 14 days. For the antibiotic resistance determinations, subgingival plaque samples were taken from six posterior teeth at baseline, and 90 days; and from two randomly selected teeth at 3, 7 and 14 days during and after antibiotic administration. Samples were plated on enriched blood agar plates with or without either 2 micro g/mL metronidazole or 2 micro g/mL amoxicillin. Colonies were counted at 7 days. Significant differences in percentage of resistant organisms over time were determined by the Quade test. Microbial growth was washed from antibiotic-containing media and the identity of species determined using checkerboard DNA-DNA hybridization. Data were compared with those obtained in a previous study from subjects receiving SRP only or SRP followed by 14 days of orally administered doxycycline. The level of doxycycline used to determine antibiotic resistance in that study was 4 micro g/mL. RESULTS: The mean percentage of resistant isolates increased during antibiotic administration and returned to baseline levels by 90 days post therapy. The mean percentages (+/- SEM) of isolates resistant to 2 micro g/mL metronidazole were 53 +/- 9, 65 +/- 9, 79 +/- 4 and 69 +/- 7 at baseline, 3, 7 and 14 days during antibiotic administration, and 57 +/- 4, 64 +/- 5, 62 +/- 7 and 47 +/- 6 at 3, 7, 14 and 90 days after antibiotic administration. At the same time points, the percentage of resistant isolates to amoxicillin was 0.5 +/- 0.2, 22 +/- 12, 14 +/- 5 and 37 +/- 11 during, and 31 +/- 11, 8 +/- 3, 3 +/- 2 and 3 +/- 0.6 after, administration. Antibiotic-resistant isolates of resistant species detected during or after therapy were also detected prior to therapy. The most prevalent resistant species in the metronidazole-treated group were: A. naeslundii 1, S. constellatus, A. naeslundii 2, S. mitis, S. oralis, A. odontolyticus, S. sanguis, and in the amoxicillin-treated group: S. constellatus, P. nigrescens, E. saburreum, A. naeslundii 1, S. oralis, P. melaninogenica and P. intermedia. CONCLUSIONS: Systemic antibiotic administration transiently increased the percentage of resistant subgingival species, but a major component of subgingival plaque remained sensitive to the agents during their administration. Antibiotic-resistant isolates of resistant species could be detected in samples both prior to and after therapy. However, % antibiotic-resistant isolates returned to baseline levels 90 days after antibiotic administration.     

Re-osseointegration after treatment of peri-implantitis at different implant surfaces

Peri-implantitis is a condition that includes soft tissue inflammation and rapid loss of bone. Treatment of peri-implantitis includes both antimicrobial and bone augmenting methods. The question of whether true re-osseointegration may occur following treatment of peri-implantitis is controversial. The aim of this study was to investigate whether the character of the implant surface was of importance for the occurrence of re-osseointegration following treatment of peri-implantitis. Four beagle dogs were used. The mandibular premolars were extracted. After 12 months, 3 ITI(R) solid screw dental implants were placed in each side of the mandible. In the left side, implants with a turned surface (Turned sites) were used, while in the right side implants with a SLA surface (SLA sites) were placed. After 3 months of healing, peri-implantitis was induced by ligature placement and plaque accumulation. When about 50% of the initial bone support was lost, the ligatures were removed. Five weeks later, treatment was initiated. Each animal received tablets of Amoxicillin and Metronidazole for a period of 17 days. Three days after the start of the antibiotic regimen, one implant site (experimental site) in each quadrant was exposed to local therapy. Following flap elevation, the exposed titanium surface was cleaned with the use of cotton pellets soaked in saline. The implants were submerged. Six months later, biopsies were obtained. Treatment resulted in a 72% bone fill of the bone defects at Turned sites and 76% at SLA sites. The amount of re-osseointegration was 22% at Turned sites and 84% at SLA sites. A treatment regimen that included (i) systemic administration of antibiotics combined with (ii) granulation tissue removal and implant surface cleaning resulted in resolution of peri-implantitis and bone fill in adjacent bone defects. Further, while substantial "re-osseointegration" occurred to an implant with a rough surface (SLA), bone growth on a previously exposed smooth surface (Turned) was minimal.     

Replantation of teeth and antibiotic treatment

Abstract Administration of antibiotics is usually recommended when a traumatically avulsed tooth is replanted, in order to prevent bacterial contamination. In the present study, permanent lateral incisors of monkeys were extracted, allowed to dry for 1 h and then replanted. Some teeth had their pulp chambers opened labially and left open for 3 wk after replantation. The monkeys were treated with antibiotics (i.m.) either at the lime of replantation or 3 wk after replantation. In some monkeys, antibiotics were placed in the pulpal cavity. Comparisons were made of the effect of endodontic treatment on periodontal healing and root resorption. The monkeys were killed 8 wk after replantation. It was found that after systemic antibiotic treatment at the time of replantation there was no inflammatory root resorption. Also, endodontic treatment at the time of replantation prevented inflammatory root resorption. When systemic antibiotic treatment was instituted 3 wk after (he replantation, there was no reduction of the inflammatory root resorption as compared with teeth without antibiotic treatment. Application of antibiotics in the pulp 3 wk after replantation almost completely eliminated the inflammatory resorption. In all the treatment groups where administration of antibiotics or endodontic treatment had prevented, reduced or eliminated inflammatory root resorption, 30–45% of the root surface area was ankylotic 8 wk after replantation.     

Efficacy of antibiotics to strains of periodontopathogenic bacteria within a single species biofilm - an in vitro study

OBJECTIVES: This study examined differences in the efficacy of antibiotics against a single strain of three periodontal pathogens grown in an artificial biofilm. METHODS: Single species biofilms were established with artificial saliva and one of the following bacterial strains: Actinobacillus actinomycetemcomitans Y4, Streptococcus constellatus 384b (a clinical isolate) and Porphyromonas gingivalis ATCC 33277. The efficacy of the antibiotics clindamycin, doxycycline, metronidazole, and moxifloxacin to these bacteria was determined using concentrations up to 100-fold minimal inhibitory concentration (MIC) to planctonic bacteria over 48 h. RESULTS: The ability of the bacteria to form a biofilm varied. The biofilms of S. constellatus 384b and A. actinomycetemcomitans Y4 contained more viable bacteria and showed a larger thickness in SEM photographs than those of P. gingivalis ATCC 33277. The antibiotics tested showed different efficacy for the different strains. Moxifloxacin was the most efficient antibiotic: onefold MIC was sufficient to eliminate A. actinomycetemcomitans Y4 and P. gingivalis ATCC 33277 after 48 h. However, only the 50-fold MIC completely eradicated S. constellatus 384b. SEM photographs underlined the damaging effect of moxifloxacin on the biofilm structure. CONCLUSION: The complete removal of bacteria by the use of antibiotics alone seems to be impossible when taking into account MIC values and the level of antibiotics in gingival fluid.     

Killing of Fusobacterium nucleaturn,Porphyromonas gingivalis and Prevotella intermedia by protegrins

Protegrins are broad spectrum antibiotic peptides isolated from porcine leukocytes. In this study, we (i) examine the sensitivity of Gram-negative, anaerobic periodontal pathogens to synthetic protegrins; (ii) determine the relative potencies of protegrin congeners against these bacteria; and (iii) compare the potency of protegrins with other antibiotic peptides, including magainin MSI-78, tachyplesin I, cecropin P1, human defensins HNP-1-3, and clavanin A. Synthetic l - and d -enantiomers of protegrin 1 (PG-1 and D-PG-1, respectively), and L-enantiomers of protegrins 2, 3 and 5 (PG-2, PG-3 and PG-5) were tested against Fusobacteriurn nucleatum, and black-pigmented organisms including Porphyromonas gingivalis and Prevotella intermedia. Strains of both F. nucleatum and the black-pigmented organisms were sensitive to PG-1, and exhibited mean ED₉₉ of 2.2-2.3 μg/ml and 3.4-9.9 μg/ml, respectively. The D-form was statistically more potent than the L-form against these oral anaerobes, and although this difference in potency is unlikely to be of decisive therapeutic significance, the d -form may be of value given ability to resist microbial and host-derived proteases. PG-1 was more potent than magainin, tachyplesin, cecropin, defensins and clavanin under test conditions. Hypertonic saIt concentrations and heat-inactivated serum were found to be inhibitory to the bactericidal activity of PG-1. PG-1 was found to induce morphologic alterations in the ultrastructural appearance of F. nucleatum consistent with damage to the bacterial membranes. We conclude that protegrins may be useful antimicrobial agents in therapy against Gram-negative anaerobic bacteria believed to be involved in chronic, adult forms of periodontal infections.     

Should prophylactic antibiotics be used for patients having removal of erupted teeth?

Generally, antibiotics should not be required before the removal of erupted carious or periodontally involved teeth unless a significant risk of postoperative infection is present. The decision to use prophylactic antibiotics in noninfected cases should also be based on whether patients have any significant medical risk factors that could adversely affect their humoral and cellular defense mechanisms, and whether any systemic risks are associated with the bacteremia that accompanies tooth extraction. This article discusses the various indications for using prophylactic antibiotics in patients having erupted teeth extracted based on a consideration of these factors.     

2021—2022年天津市口腔医院病区预防性应用抗菌药合理性评价及风险模型探索

目的 对2021—2022年天津市口腔医院病区预防性应用抗菌药合理性进行评价,分析预防用药的影响因素,构建风险预测模型,筛选预防用药高危人群,明确用药指征,为口腔医院临床合理用药提供参考。方法 收集2021—2022年天津市口腔医院5 863例住院患者的病历资料作为研究对象,采用SPSS 26.0软件以及R4.0.3软件进行数据分析,使用率和百分比评价预防性应用抗菌药的合理性;通过χ²检验、二元Logistic回归分析预防性应用抗菌药的影响因素,构建预防用药风险预测模型。结果 2021—2022年天津市口腔医院病区预防性抗菌药使用率为42.01%,其中单联用药占98.09%、非限制级用药占90.41%、头孢菌素类占66.78%、不合理用药占46.16%。不合理用药的主要原因是术后用药时间过长、术前给药或术中追加用药时机不当、用药品种选择不当等。多因素分析：年龄、住院天数、手术切口类别、手术时长是口腔住院患者预防用药的影响因素（P<0.05）,基于上述风险因素构建预防性应用抗菌药的风险预测模型。结论 2021—2022年天津市口腔医院病区患者预防性抗菌药使用存在诸多不合理现象,分析预防用药的影响因素很多且相互关联;口腔类机构可根据由年龄、住院天数、切口类别、手术时长对住院患者建立预防性应用抗菌药的风险模型,筛选预防用药高危人群,明确预防用药指征,提高合理用药水平。