[Soft tissue infections in oral, maxillofacial, and plastic surgery. Bacterial spectra and antibiotics].

BACKGROUND: Soft tissue infections in the maxillofacial region are mainly caused by Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli but also by members of the genera Enterococcus, Klebsiella, and Enterobacter, respectively.
METHODS: In a prospective study 96 patients with severe maxillofacial non-odontogenic postoperative soft tissue infections were analyzed with regard to the bacterial spectrum and resistance patterns against antibiotics. The dominating bacteria were Streptococci (25% of the isolates) and Staphylococci (24% of the isolates). In addition, members of Enterobacteriaceae were isolated in approximately 10% of the cases. The most frequent anaerobes found were as follows: Peptostreptococcus, Eubacterium, Prevotella and Fusobacterium.
RESULTS: The resistance rates against antibiotics found were: penicillin G 36%, ampicillin 42%, and doxycycline 36%. In addition, the resistance rate against erythromycin and clindamycin was 26% and 7%, respectively. No resistant strains were detected against vancomycin and teicoplanin. All anaerobes showed a low antimicrobial resistance as previously described for odontogenic infections.
CONCLUSION: In summary, soft tissue infections in the maxillofacial region present a different spectrum of bacteria in contrast to the well-investigated odontogenic infections. Antibiotic administration should be, whenever possible, performed after differentiation of involved strains and resistogram. The most promising antibiotics are imipenem, meropenem, and ciprofloxacin as well as cefotiam. Modern fluoroquinolones will be the antibiotics of the future.