目的:感染在MRONJ患者治疗中的重要作用已被广泛接受。对MRONJ病变生物膜作为潜在病原体的研究似乎是合乎逻辑的。
方法:我们调查了在疾病晚期接受手术的MRONJ患者的临床资料。特别注意从骨MRONJ标本和粘膜下腐烂感染中收获的局部定植者。
结果:71例患者中有11例表现为自发发病,71例患者中有60例检测到触发因素。乳腺癌(29.6%)和前列腺癌(22.5%)是抗吸收治疗处方中最常见的潜在疾病,主要是唑来膦酸.粘膜下软组织生物膜与从MRONJ病变底部收获的生物膜显着不同,然而,在两组中最常见的细菌同样存在:链球菌属(spp.),普雷沃氏菌属。,放线菌属。,Veillonella属。,和Parvimonasmicra.头孢菌素,头孢呋辛和头孢噻肟,β-内酰胺抗生素和β-内酰胺酶抑制剂显示对检测到的细菌的敏感性最高。
结论:来自粘膜下区域和感染骨底部的细菌与普通抗生素方案的敏感性相当。链球菌属。,普雷沃氏菌属。,和Veillonellaspp.除放线菌属外,MRONJ病变中的丰度很高。在许多情况下,MRONJ病变底部未被放线菌感染。
结论:去除坏死骨减少了MRONJ病变中发现的细菌种类,特别是在病变的底部。
OBJECTIVE: A central role of infections in the treatment of MRONJ patients is widely accepted. An investigation of the MRONJ lesions\' biofilms as potential pathogens seems logical.
METHODS: We investigated the clinical data of our MRONJ patients who received surgery in advanced stage of the disease. Special attention was granted to the local colonizers harvested from osseous MRONJ specimens and submucosal putrid infections.
RESULTS: Eleven out of 71 patients presented a spontaneous onset of the disease and for 60 out of 71 patients a trigger was detected. Breast cancer (29.6%) and prostate cancer (22.5%) were the most frequent underlying disease for prescription of an antiresorptive therapy, mostly zoledronate. Submucosal soft tissue biofilms significantly differed from biofilms harvested from the MRONJ lesions bottom, yet the most frequent bacteria were equally present in both groups: Streptococcus species (spp.), Prevotella spp., Actinomyces spp., Veillonella spp., and Parvimonas micra. The cephalosporins, cefuroxime and cefotaxime, and ß-lactam antibiotics with ß-lactamase inhibitor revealed the greatest susceptibility for the detected bacteria.
CONCLUSIONS: The bacteria from the submucosal areas and the bottom of the infected bone presented comparable susceptibility to the common antibiotics regimes. Streptococcus spp., Prevotella spp., and Veillonella spp. present a high abundance in MRONJ lesions beside Actinomyces spp. The MRONJ lesions bottom is in many cases not infected by Actinomyces spp.
CONCLUSIONS: The removal of the necrotic bone reduces the variety of bacteria found in MRONJ lesions, in particular at the bottom of the lesion.