Bacteriological And Clinical Evaluation Of Twelve Cases Of Post-Surgical Sepsis Of Odontogenic Tumours At A Referral Centre

Abstract

Objective: To determine the bacterial aetiology of sepsis occurring following surgery of odontogenic tumours and assess the effect of prompt and proper antibiotic usage. Design: A prospective study.
Setting: A tertiary referral centre in Lagos, Nigeria.
Subjects: Twelve patients with odontogenic tumours that developed sepsis postoperatively.
Eight of the patients were referred from private hospitals, the remaining were in-patients who sought for alternative medical attention following interruption of health care services at the referral centre.
Intervention: Adequate review of patient\'s medical history, bacteriological investigations and
antibiotic therapy.
Main outcome measures: Bacteriological and clinical cure following antibiotic therapy based on susceptibility test results.
Results: Two categories of patients were identified; those who completed the course of antibiotics prescribed post-surgery and patients who failed to conform to antibiotic prescription. Sepsis developed in the non-compliance group much earlier than in the group that complied (p<0.001). Infections were polybacterial with aerobes accounting for 77.4% (α-haemolytic streptococci 29.0%, Streptococcus pyogenes 16.1%, Staphylococcus aureus 16.1%, diphtheroids 9.7%, Klebsiella pneumoniae 6.5%) and anaerobes 22.6% (Porphyromonas gingivalis 9.7%, Peptostreptococcus spp. 6.5%, Prevotella melaninogenica 3.2%, Clostridium perfringens 3.2%). Mixed aerobic and anaerobic aetiology occurred more in osteosarcoma and fibrosarcoma. Clostridium perfringens was isolated from a case of osteosarcoma with necrotic tissues. The anaerobic bacteria were 100% sensitive to
metronidazole, ciprofloxacin and augmentin, 65-85% sensitivity to ampicloxacillin, amoxicillin
and erythromycin. Over 92% of the streptococci were sensitive to the β-Lactams contrast low susceptibility with S. aureus and K. pneumoniae.
Conclusion: Interruption of healthcare service was the sole factor identified in the development of sepsis as the patients could not be monitored to ensure compliance to prescription.

East African Medical Journla Vol. 85 (6) 2008: pp. 269-274