Institutional microbial analysis of odontogenic infections and their empirical antibiotic sensitivity

Pediatric Odontogenic Infections

Odontogenic infections are a broad group of head and neck conditions that arise from the teeth and surrounding periodontium. These largely preventable infections disproportionately affect members of ethnic and racial minorities and low-income/uninsured groups, and result in significant costs to our health care system. Left untreated, odontogenic infections can spread to deep spaces of the head and neck and can result in life-threatening complications. The mainstay of treatment includes timely treatment of the affected teeth. These infections are a global public health concern that could be diminished with improved access to routine dental care.

Etiology and Demographic Distribution of Odontogenic Abscesses in the Maxillofacial Area in Patients Over 18 Years of Age: A Five-Year Retrospective Study

Introduction Despite the constant development of medicine and the increasing accessibility to medical specialists, in the first quarter of the 21st century, odontogenic abscesses remain one of the leading causes of emergency hospitalization in maxillofacial surgery clinics. Because of the serious and lethal complications that this type of suppurative infection can lead to if not treated promptly, there is a need for constant updating of the knowledge of its origin, which is precisely what is addressed in this original article. Materials and methods It reports on a retrospective study conducted over a five-year period (2018-2023), during which 705 patients aged 18 years and older with a confirmed diagnosis of odontogenic soft tissue abscess of the head and neck underwent emergency surgery. Results The average age of the patients studied was 41 years, with the oldest being an 82-year-old woman. The proportion of males in the study population was higher - 54.18%. Young patients (18-44 years) were the most affected, with a total of 364 patients (213 males and 151 females), while the proportion of old people (75 years of age and older) was the lowest, with a total of 15 patients, including seven males and eight females. The first molars of both jaws (16, 26, 36 and 46) were the cause of the suppurative bacterial infection in the highest number among our study patients - 208 out of 705 (29.5%). Central incisors (teeth 11, 21, 31 and 41) were the least frequent direct cause of odontogenic infection, accounting for only 17 cases out of 705 (2.41%). Discussion The most logical reason for the decrease in the number of patients with odontogenic abscesses with increasing age is tooth loss in older individuals. Our study confirmed the knowledge that the first mandibular molars are the most common teeth leading to the formation of purulent exudate in the adjacent mandibular soft tissues. However, in contrast to the well-known fact for the maxilla that canines are the most frequent etiologic factor for the occurrence of odontogenic abscesses, we conclude that again the first molars (teeth 16 and 26) outnumber the other teeth of the maxillary dentition, with canines outnumbering only incisors. The teeth of the lower jaw are the cause of more than twice as many exudative infections as those of the upper jaw - the ratio between them is 2.54:1. Conclusions Knowledge of odontogenic abscesses - their demographic distribution, frequency and etiology, their diagnosis and treatment - is the basis for the prediction and treatment outcome of these diseases, mainly affecting young people. Their treatment is both surgical in order to evacuate the suppurative focus, and antibacterial.

Antimicrobial therapy in the management of odontogenic infections: the penicillin-allergic patient

This retrospective analysis was performed to investigate whether clindamycin remains the preferred antibiotic for penicillin-allergic patients with odontogenic infections. The medical records of 311 patients admitted to the study department with odontogenic infections between 2018 and 2022 and treated with either intravenous amoxicillin-clavulanic acid (Augmentin) or intravenous clindamycin were analyzed. The Augmentin-treated group included 268 patients (86.2%) and the clindamycin-treated group included 43 patients (13.8%). Severity parameters did not differ significantly between the two groups, except for a higher prevalence of abscesses in the clindamycin-treated group (58.1% vs 41.0% in the Augmentin-treated group; P = 0.035). The clindamycin-treated group required a longer duration of intravenous antibiotics (P = 0.001) and had a higher rate of treatment failure (14.0% vs 2.2%; P = 0.002) when compared to the Augmentin-treated group, with a seven-fold increased risk of treatment failure. Moreover, significantly more isolated organisms in the clindamycin-treated group were resistant to clindamycin (P = 0.015); these were all Streptococcus anginosus group. Given the higher risk of treatment failure with clindamycin, it is necessary to choose the antibiotic treatment for penicillin-allergic patients carefully. A detailed history and allergy testing followed by combination therapy is recommended, especially in severe cases.

The empirical use of aminoglycosides in Ludwig's angina based on bacterial analysis of 63 cases

PURPOSES

To determine if the empirical use of aminoglycosides is justified in Ludwig's angina based on microscopy, culture and sensitivity results.

METHODS

A retrospective analysis was done on patients that presented with Ludwig's angina to the Maxillofacial and Oral surgery department at the University of Pretoria. Demographical data was extracted from patient files. Pus specimens that were submitted as part of the initial surgical intervention were analysed.

RESULTS

Sixty-three patients were included in the study with the majority, 76.19% (n=48/63), comprising males. The mean patient age was 38.6 years (range 6 months to 78 years). The majority of infections (87.3%) had an odontogenic aetiology (n=55/63). Forty-four percent of the patients had immunosuppressive co-morbidities (n=28/63). Streptococci contributed 71.26% (n=62/87) of the cultured bacteria. Similar bacteria were cultured in the immunocompromised and the immunocompetent patients (p=0.672). Ninety-two percent (n=57/62) of the streptococci cultured were sensitive to penicillin. The addition of aminoglycosides to the study sample would not have made a statistically significant difference (p=0.1556).

CONCLUSION

Based on the findings of this study, the empirical use of aminoglycosides is not warranted in either immunocompromised or immunocompetent patients with Ludwig's angina.

Antimicrobial resistance in odontogenic infections: A protocol for systematic review

BACKGROUND

It is estimated that up to 90% of head and neck infections have an odontogenic origin, which are considered among the most common in the oral cavity and maxillofacial region. Bacterial resistance has been 1 of the main problems related to the treatment of this type of infection in recent years. The frequency of this resistance is increasing, which is mainly due to patient self-medication and the mutations that bacteria present. Therefore, the objective of this study is to analyze the antimicrobial resistance of antibiotics commonly administered for the treatment of odontogenic infections.

METHOD

To carry out the study, PubMed, ScienceDirect, and Scopus databases were reviewed using the keywords "odontogenic infection", "pharmacological treatment", and "microbial resistance. Studies whose main objective was the pharmacological treatment of odontogenic infections were selected. Exclusions were review-type studies, systematic reviews, or in vitro or animal model studies. For the analysis of risk of bias, the Checklist for Analytical Cross-Sectional Studies of the Joanna Briggs Institute was used. The search and analysis of the studies was carried out by 2 researchers independently.

RESULTS

A total of 13 studies were included in this review. The mean age was 39.6 years; the location of the infection in the study subjects was in the submandibular and vestibular spaces; there were periodontal, periapical, and dentoalveolar lesions; the main microorganisms identified were Streptococcus, Staphylococcus, Prevotella, Peptostreptococcus, Clostridium, and Klebsiella; and finally, the main microorganisms identified for bacterial resistance were penicillin, clindamycin and amoxicillin.

CONCLUSION

The health professional is obliged to update their knowledge to avoid such antibiotic resistance and thus provide better patient care.

Clinical, CT scan, and laboratory changes of abscess patients with odontogenic origin admitted to Shiraz acute surgical care center, Iran

Introduction

Rapid diagnosis of maxillofacial abscess with the odontogenic origin is effective in the treatment of patients. This study aimed to check the clinical evaluation, head, and neck computed tomography (CT) scan, and microbial sensitivity of hospitalized patients diagnosed with maxillofacial abscess admitted to the Maxillofacial Surgery Ward Shaheed Rajaie Surgical Acute Care Center of Shiraz, Iran from 2019-2021.

Method

A cross-sectional study was conducted. The sample included patients diagnosed with the abscess of odontogenic origin. Data collection tools included personal profile registration form, chief complainant and clinical evaluation, laboratory test results, pus culture, antibiogram results, and head and neck CT scan changes form. Data was reported with descriptive statistics by SPSS-16 software.

Results

The majority of patients were male; infection duration was 10 days; maximum mouth opening size was less than 20 mm in more than half of patients. The scan revealed 41.8% abscess, 36.4% cellulite, and 21.8% mixed abscess and cellulitis. There was 29.1% involvement of salivary glands. The majority of abscesses were unifocal involved in the submandibular space, and the least involvement was in peri mandibular space and carotid sheath. The most common organism causing was staphylococcal abscess coagulase-negative.

Conclusion

In patients with maxillofacial abscess requiring hospitalization, the most common clinical features were trismus, toxic appearance, and dysphagia, and the most common source of abscess in scanning patients with mandibular molars was the most involved submandibular space and pterygomandibular space. Vancomycin, cotrimoxazole, and cefazolin had the greatest effect in the treatment of odontogenic infections in terms of antibiogram results and microbial culture.

Targeting antibiotic tolerance in anaerobic biofilms associated with oral diseases: Human antimicrobial peptides LL-37 and lactoferricin enhance the antibiotic efficacy of amoxicillin, clindamycin and metronidazole

Antimicrobial peptides are receiving increasing attention as potential therapeutic agents for treating biofilm-related infections of the oral cavity. Many bacteria residing in biofilms exhibit an enhanced antibiotic tolerance, which grants intrinsically susceptible microorganisms to survive lethal concentrations of antibiotics. In this study, we examined the effects of two endogenous human antimicrobial peptides, LL-37 and human Lactoferricin, on the antibiotic drug efficacy of amoxicillin, clindamycin and metronidazole in two types of polymicrobial biofilms, which aimed to represent frequent oral diseases: (1) facultative anaerobic (Streptococcus mutans, Streptococcus sanguinis, Actinomyces naeslundii) and (2) obligate anaerobic biofilms (Veillonella parvula, Parvimonas micra, Fusobacterium nucleatum). LL-37 and Lactoferricin enhanced the anti-biofilm effect of amoxicillin and clindamycin in facultative anaerobic biofilms. Metronidazole alone was ineffective against facultative anaerobic biofilms, but the presence of LL-37 and Lactoferricin led to a greater biofilm reduction. Obligate anaerobic biofilms showed an increased drug tolerance to amoxicillin and clindamycin, presumably due to metabolic downshifts of the bacteria residing within the biofilm. However, when combined with LL-37 or Lactoferricin, the reduction of obligate anaerobic biofilms was markedly enhanced for all antibiotics, even for amoxicillin and clindamycin. Furthermore, our results suggest that antimicrobial peptides enhance the dispersion of matured biofilms, which may be one of their mechanisms for targeting biofilms. In summary, our study proves that antimicrobial peptides can serve as an auxiliary treatment strategy for combatting enhanced antibiotic tolerance in bacterial biofilms.

Predictors of longer hospitalization of maxillofacial infections-a 17-year retrospective study

OBJECTIVES

To evaluate treatment outcomes in patients with severe maxillofacial infections requiring hospital care during a 17-year period.

METHODS

A retrospective cohort study reviewed 5,465 medical records, and the following data were collected: the reason for infection, locations of inflamed regions, treatment provided, bacteriological findings, and treatment outcomes. Other information included sociodemographic characteristics (age, gender), presence of systemic diseases, and smoking history.

RESULTS

The annual incidence rate of patients with acute maxillofacial infections was 206 ± 19 cases with a male to female ratio 1.4:1.0, a mean hospital stay of 7.9 ± 4.9 days. Older age (>65 years), smoking and systemic diseases (diabetes), the causative tooth (molar), and need for extraoral incision predicted longer hospitalization. Intravenous penicillin was the most common drug prescribed in 50.5% of cases. A total of 132 different microorganisms were identified. The highest microorganism resistance occurred for metronidazole and the highest sensitivity was to clindamycin.

CONCLUSIONS

Increased age, smoking, diabetes, causative tooth, and the occurrence of several infected spaces were associated with a longer hospital stay. Streptococcus α haemolyticus was the most common microorganism found in more than 70.0% of cases that were sensitive to intravenous penicillin.

A systematic review of orbital apex syndrome of odontogenic origin: Proposed algorithm for treatment

Orbital apex syndrome (OAS) can be a rare, but severe complication of an odontogenic infection and has high morbidity and mortality. Antibacterial drugs are typically an appropriate treatment choice, but the most severe cases are fungal in nature and pose a tough challenge to the clinician. The aim of this study was to determine the predisposing factors, specific aspects in its management and the appropriate treatment strategy in order to improve patient outcome. A systematic review was conducted using PubMed, PubMed Central, Web of Science, and Scopus up to February 2020, based on the associations between dental extraction or infections and OAS. Of 721 papers found, 18 articles were considered eligible and presented in total 21 cases (13 fungal and eight bacterial infections). The information was organized into a diagnostic and treatment algorithm which included data extracted both from the included cases and updated literature of treatment efficacy studies. Immunosuppression (uncontrolled diabetes mellitus and chemotherapy) was found as an important predisposing factor particularly for fungal infections. In these cases, we suggest that early simultaneous approaches, including aggressive surgical procedures and systemic administration of amphotericin B, result in a better outcome. In conclusion, medical intervention success depends on aggressive treatment and multidisciplinary teamwork.

Cefazolin versus ampicillin/sulbactam as an empiric antibiosis in severe odontogenic neck infection descending from the lower jaw-retrospective analysis of 350 cases

OBJECTIVES

Odontogenic infections descending from the lower jaw may lead to severe health conditions. Commonly, a biphasic treatment of surgical drainage and antibiotic therapy is conducted. The choice of the administered empiric antibiotic agent remains debatable.

MATERIAL AND METHODS

Retrospectively, we analyzed 350 medical records of patients who were consecutively treated with odontogenic infections descending from the lower jaw. All patients received surgical drainage and either cefazolin or ampicillin/sulbactam as empiric antibiosis. In particular, the number of secondary operations, infectious parameters, and length of in-hospital stay were investigated.

RESULTS

The most frequently infected space was the perimandibular/buccal space for both groups followed by the submandibular space. Number of revision procedures, early recurrence, and length of stay presented no significant difference between both groups (p > 0.05). Inflammatory parameters (c-reactive protein, leukocytes) similarly decreased in both groups.

CONCLUSION

Cefazolin targets the majority of the pathogens detected in severe odontogenic neck infections descending from the lower jaw and reveals comparable results to AMP/S in regard to the inflammatory parameters and in-hospital stay.

CLINICAL RELEVANCE

Cefazolin is a feasible empiric antibiosis for odontogenic neck infections descending from the lower jaw if surgical drainage is performed.