歯原性上顎洞炎患者におけるマイクロフローラの種構成と感受性の包括的評価

[COMPREHENSIVE ASSESSMENT OF THE SPECIES COMPOSITION AND SENSITIVITY OF MICROFLORA IN PATIENTS WITH ODONTOGENIC MAXILLARY SINUSITIS].

抄録

目的-歯原性上顎洞炎患者における微生物叢の種構成とその感度を調査する。研究対象は、M. F. Vladimirskyの名を冠したモスクワ地域科学研究臨床研究所で歯原性上顎洞炎と診断されて治療を受けた18歳から70歳までの男女230名である。このうち，上顎洞穿孔と口腔肛門瘻を合併した歯原性上顎洞炎患者は155名，上顎アスペルギルス症患者は75名であった。すべての患者は、上顎洞の塗抹標本と洗浄液の微生物学的検査を受け、種の構成と抗生物質の感受性を決定した。穿孔性歯原性上顎洞炎の患者の大部分では、球菌叢（連鎖球菌および様々な種）が検出されたが、それに比べて数は少なく、通性嫌気性菌および偏性嫌気性菌、病原性真菌（Candida）が検出された。上顎洞穿孔の期間に応じて微生物叢を比較分析したところ、鼻疽菌（Moraxella spp.）は術中の穿孔でのみ検出された（最大で20％の症例）。obligate anerobes（Fusobacterium spp.Bacteroides spp.）の存在は、長く続いている穿孔に典型的であった。上顎アスペルギルス症の患者では、穿孔性上顎洞炎の患者に比べて、通性嫌気性菌および obligate 嫌気性菌の検出頻度は低く、種類も少なかった。このグループでは、Candida属の病原性真菌による副鼻腔汚染の症例はなかった。同時に、この患者群では、鼻腔内微生物（Moraxella spp.）が高い頻度（最大27.3％）で検出された。

Objective - to study the species composition of microflora and its sensitivity in patients with odontogenic maxillary sinusitis. The study included 230 patients of both sexes aged 18 to 70 years, who were treated at the Moscow Regional Scientifics Research and Clinical Institute named after M. F. Vladimirsky with a diagnosis of Odontogenic maxillary sinusitis. Of these, there were 155 patients with odontogenic sinusitis, complicated by perforation of the maxillary sinus and the presence of an oro-antral fistula, and 75 patients with maxillary aspergillosis. All patients underwent microbiological examination of smears and flushes from the maxillary sinus cavity with the determination of the species composition and antibiotic sensitivity. In the majority of the patients with perforative forms of odontogenic maxillary sinusitis, coccal flora (streptococci and various species) was detected, in a smaller number compared to it - facultative and obligate anaerobes, pathogenic fungi (Candida). A comparative analysis of the microflora, depending on the duration of the maxillary sinus perforation, showed that the rhinogenic microorganisms (Moraxella spp.) were found only in intraoperative perforations (up to 20% of cases). The presence of obligate anaerobes (Fusobacterium spp. Bacteroides spp.) was typical for long-existing perforations. In patients with maxillary aspergillosis facultative and obligate anaerobes were found less frequently and in a smaller variety than in patients with perforative maxillary sinusitis. There were no cases of sinus contamination by pathogenic fungi of the genus Candida in this group. At the same time, rhinogenic microgranisms (Moraxella spp.) were detected with a higher frequency (up to 27.3%) in this group of patients.