Bacteriology Analysis of Wound Infection Following Oral Cancer Surgery

口腔癌術後傷口感染的細菌學分析

郭耀仁(Yur-Ren Kuo) ； 劉奕添(Yi-Tien Liu) ； 張簡志炫(Chih-Hsuan Chang Chien) ； 曹賜斌(Su-Ben Tsao)

《中華民國重建整形外科醫學會雜誌》 5卷2期 (1996/06) Pp. 71-77

https://doi.org/10.7096/JPRSA.199606.0071

摘要

傷口感染是口腔癌手術後最常見的合併症，除造成住院日期延長，甚至導致病人死亡。本文目的在分析有那些細菌引起這種術後感染，並作為將來選用抗生素的參考，減少合併症發生。
從1990年1月至1995年1月止，回顧性統計本院25個因口腔癌術後造成傷口感染病例，細菌學分析顯示其為多菌性(polymicrobial)感染者佔92% (23/25)。依菌種分析報告中，在嗜氧菌方面，以Streptococcus viridans (15/25)較多，其次是Pseudo-monas aeruginosa (9/25)、Enterococcus (8/25)及E. coli (6/2)。在厭氧菌方面，以Bacteroid melaninogenicus (9/25)及Bacteroid sp (6/25)佔多數。正確抗生素的使用在預防感染方面仍是重要的一環。而當傷口感染時，須足夠的外科傷口引流及合併使用廣效抗生素，以避免敗血症等嚴重合併症發生。依抗菌試驗選用廣效抗生素如Cefamandle、第三代Cephalosporin、Ticarcillin、Piperacillin等可以對付Gram(+)及Gram(-)菌；配合Clindamycin、Metronidazole等對付厭氧菌感染是有效的選擇。

並列摘要

Wound infection following major oral cancer sugery is a common complication which leads to a significant morbidity and prolonged hospitalization.
Bacteria of wound discharges was studied in 25 patients after major oral cancer surgery from Jan. 1990 to Jan. 1995 in Kaohsiung CGMH, polymicrobials were identified in 92% (23/25) of cases. Among aerobic culture, Streptococcus are the most common, especially Streptococcus viridans species (15/25), followed by Pseudomonas aeruginosa (9/25), Enterococcus (8/25) and Escherichia coli (6/25). Among anaerobic culture, Bacteroid melaninogenicus (9/25) and Bacteroid species (6/25) are the most common pathogens.
Proper selection of antibiotics for perioperative use is still important for the prophylactic option. The priority of treatment of infected wound is adequate open drainage by suture removal and accompanied by broad spectrum antibiotics coverage.
Sensitivity test of the bacteria shows penicillin group (Ticarcillin, Pipril, Ampicillin), aminoglycoside group (Amikacin, Netilmicin, Gentamicin) or 3° Cephalosporin are effective. Clindamycin and metronidazole groups are selected for combat anaerobic bacteroids. There is no septic mortality in our series.

並列關鍵字

wound infection ； oral carcer ； bacteriology