ESKAPE균에 의한 구강악안면 감염: 5년간의 후향적 임상 연구

Abstract

I. Introduction Most cases of oral and maxillofacial infections are caused by bacteria of normal oral flora, and they are usually easily treated by proper diagnosis, elimination of causative factors, and antibiotic therapy. However, the emergence of multi-drug resistant bacteria and the increase of infections caused by these antibiotic-resistant bacteria make treatment challenging. "ESKAPE" pathogens, consist of Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species, are the most common opportunistic organisms in nosocomial infections and have resistant to commonly used antibiotics. There are many medical reviews of ESKAPE pathogens, but few in oral and maxillofacial regions.

II. Purpose This study focuses on oral and maxillofacial infection especially with ESKAPE pathogens. The purpose of this study is to prepare feasible data about tracing and treatment of infection related to pathogens that may be beneficial to clinicians.

III. Subjects and Methods A total of 154 patients with oral and maxillofacial infections were reviewed by analyzing retrospectively hospitalized data in the Department of Oral and Maxillofacial surgery, Chosun University Hospital past 5 years from 2014 to 2018. The criteria included patients' age, sex, causative factor, site, medical history, duration and characteristics of treatment, and other clinical parameters. And based on the medical records and microbiological tests, the results were divided into two groups: infections with ESKAPE pathogens (ESKAPE group) and other bacteria (Non-ESKAPE group).

IV. Results A total of 22 species were isolated from 154 patients. The proportion of ESKAPE pathogens among all bacterial isolates collected from infected patients was 39.6% (61/154). The main sites of infection were the mandibular molar area (47.5%) and the maxillary molar area (14.8%). Causative factors, especially in post-operative infection, showed a statistically significant correlation to ESKAPE infection. For the post-operative infections such as open surgery of oral and maxillofacial region and endodontic or periodontal treatment, ESKAPE groups accounted for 29 cases (59.2%), compared with 49 cases of all analyzed patients. And average of treatment period in ESKAPE group (2.15month) was longer than Non-ESKAPE groups (0.95month). Overall, K.pneumoniae (60.7%) was the most frequently isolated ESKAPE pathogen followed by S.aureus (24.6%), Enterobacter spp. (18.0%), P.aeruginosa (3.3%), A.baumannii (1.6%). Of the 154 patients, 9 patients had to change antibiotics during their treatment time and 8 cases of them were ESKAPE groups. High antibiotic resistance rates had been detected in the ESKAPE during the five-year period. The most common resistance pattern in Gram-negative pathogens was resistance to amoxicillin-clavulanic acid and cephalosporins.

V. Conclusion For clinicians, antimicrobial-resistant bacteria and ESKAPE pathogens should be distinctly considered. Infections with ESKAPE pathogens are now a problem that can no longer be overlooked in Dentistry. Based on results of this study, ESKAPE pathogens were highly associated with post-operative or opportunistic infections. Clinicians should be careful about these antibiotic resistant pathogens and use appropriate antibiotics to patients while having dental treatments.