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Sanjar F, Silliman DT, Johnson IJ, Htut Z, Peacock TJ, Thompson SF, Dion GR, Nahid MA, Decker JF, Leung KP. Identification of temporal shifts of oral bacteria in bone regeneration following mandibular bone defect injury and therapeutic surgery in a porcine model. Mol Oral Microbiol 2024; 39:381-392. [PMID: 38511906 DOI: 10.1111/omi.12460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 12/07/2023] [Accepted: 02/13/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Considered the second largest and most diverse microbiome after the gut, the human oral ecosystem is complex with diverse and niche-specific microorganisms. Although evidence is growing for the importance of oral microbiome in supporting a healthy immune system and preventing local and systemic infections, the influence of craniomaxillofacial (CMF) trauma and routine reconstructive surgical treatments on community structure and function of oral resident microbes remains unknown. CMF injuries affect a large number of people, needing extensive rehabilitation with lasting morbidity and loss of human productivity. Treatment efficacy can be complicated by the overgrowth of opportunistic commensals or multidrug-resistant pathogens in the oral ecosystem due to weakened host immune function and reduced colonization resistance in a dysbiotic oral microbiome. AIMS To understand the dynamics of microbiota's community structure during CMF injury and subsequent treatments, we induced supra-alveolar mandibular defect in Hanford miniature swine (n = 3) and compared therapeutic approaches of immediate mandibullar reconstructive (IMR) versus delayed mandibullar reconstructive (DMR) surgeries. METHODS Using bacterial 16S ribosomal RNA gene marker sequencing, the composition and abundance of the bacterial community of the uninjured maxilla (control) and the injured left mandibula (lingual and buccal) treated by DMR were surveyed up to 70-day post-wounding. For the injured right mandibula receiving IMR treatment, the microbial composition and abundance were surveyed up to 14-day post-wounding. Moreover, we measured sera level of biochemical markers (e.g., osteocalcin) associated with bone regeneration and healing. Computed tomography was used to measure and compare mandibular bone characteristics such as trabecular thickness between sites receiving DMR and IMR therapeutic approaches until day 140, the end of study period. RESULTS Independent of IMR versus DMR therapy, we observed similar dysbiosis and shifts of the mucosal bacteria residents after CMF injury and/or following treatment. There was an enrichment of Fusobacterium, Porphyromonadaceae, and Bacteroidales accompanied by a decline in Pasteurellaceae, Moraxella, and Neisseria relative abundance in days allotted for healing. We also observed a decline in species richness and abundance driven by reduction in temporal instability and inter-animal heterogeneity on days 0 and 56, with day 0 corresponding to injury in DMR group and day 56 corresponding to delayed treatment for DMR or injury and immediate treatment for the IMR group. Analysis of bone healing features showed comparable bone-healing profiles for IMR vs. DMR therapeutic approach.
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Affiliation(s)
- Fatemeh Sanjar
- Combat Wound Care Group, US Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - David T Silliman
- Combat Wound Care Group, US Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Ian J Johnson
- Combat Wound Care Group, US Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Zayer Htut
- Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Trent J Peacock
- Office of Research Compliance, Mississippi State University, Meridian, Mississippi, USA
| | - Samira F Thompson
- Carl R. Darnall Army Medical Center, Fort Hood Dental Activities-AEGD, Fort Hood, Texas, USA
| | - Gregory R Dion
- Combat Wound Care Group, US Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Md A Nahid
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - John F Decker
- Carl R. Darnall Army Medical Center, Fort Hood Dental Activities-AEGD, Fort Hood, Texas, USA
| | - Kai P Leung
- Combat Wound Care Group, US Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
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Mendes BM, Bortoli ÉS, Zaleski CB, Martinelli MPD, Pascoal VF, Oliveira SD. Detection of multidrug-resistant bacteria in the nasal cavities and evaluation of sinus disorders in patients undergoing Le Fort I osteotomy. BMC Oral Health 2024; 24:533. [PMID: 38704542 PMCID: PMC11069297 DOI: 10.1186/s12903-024-04295-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 04/25/2024] [Indexed: 05/06/2024] Open
Abstract
INTRODUCTION Orthognathic surgery can lead to sinus alterations, including sinusitis, attributed to the exposure of maxillary sinuses during Le Fort I osteotomy. Furthermore, being a hospital-based procedure, there is potential risk of complications arising from bacteria prevalent in such environments. This study evaluated maxillary sinusitis occurrence and the presence of multidrug-resistant bacteria in the nasal cavity before and after orthognathic surgery. METHODS Ten patients with dentofacial deformities underwent Le Fort I osteotomy. Clinical evaluations using SNOT-22 questionnaire were performed, and nasal cavity samples were collected pre-surgery and 3-6 months post-surgery to quantify total mesophilic bacteria and detect Staphylococcus aureus, Acinetobacter baumannii, and Klebsiella pneumoniae. Cone Beam Computed Tomography (CBCT) was performed pre- and post-operatively, and the results were evaluated using the Lund-Mackay system. This study was registered and approved by the Research Ethics Committee of PUCRS (No. 4.683.066). RESULTS The evaluation of SNOT-22 revealed that five patients showed an improvement in symptoms, while two remained in the same range of interpretation. One patient developed post-operative maxillary sinusitis, which was not detected at the time of evaluation by SNOT-22 or CBCT. CBCT showed a worsening sinus condition in three patients, two of whom had a significant increase in total bacteria count in their nasal cavities. The Brodsky scale was used to assess hypertrophy in palatine tonsils, where 60% of the subjects had grade 1 tonsils, 20% had grade 2 and 20% had grade 3. None of the patients had grade 4 tonsils, which would indicate more than 75% obstruction. Two patients harboured S. aureus and K. pneumoniae in their nasal cavities. Notably, K. pneumoniae, which was multidrug-resistant, was present in the nasal cavity of patients even before surgery, but this did not result in maxillary sinusitis, likely due to the patients' young and healthy condition. CONCLUSION There was an improvement in signs and symptoms of maxillary sinusitis and quality of life in most patients after orthognathic surgery. However, some patients may still harbour multidrug-resistant bacteria, even if they are asymptomatic. Therefore, a thorough pre-operative assessment is essential to avoid difficult-to-treat post-operative complications.
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Affiliation(s)
- Bárbara M Mendes
- Laboratório de Imunologia e Microbiologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Av. Ipiranga, 6681, Porto Alegre, RS, 90619-900, Brazil
- Programa de Pós-graduação em Odontologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, RS, Brazil
| | - Évelin S Bortoli
- Laboratório de Imunologia e Microbiologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Av. Ipiranga, 6681, Porto Alegre, RS, 90619-900, Brazil
| | - Catherine B Zaleski
- Laboratório de Imunologia e Microbiologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Av. Ipiranga, 6681, Porto Alegre, RS, 90619-900, Brazil
| | - Maila P D Martinelli
- Laboratório de Imunologia e Microbiologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Av. Ipiranga, 6681, Porto Alegre, RS, 90619-900, Brazil
| | - Vanessa F Pascoal
- Laboratório de Imunologia e Microbiologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Av. Ipiranga, 6681, Porto Alegre, RS, 90619-900, Brazil
| | - Sílvia D Oliveira
- Laboratório de Imunologia e Microbiologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Av. Ipiranga, 6681, Porto Alegre, RS, 90619-900, Brazil.
- Programa de Pós-graduação em Odontologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, RS, Brazil.
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Cheng OT, Stein AP, Babajanian E, Hoppe KR, Li S, Jung H, Abrol A, Akkus A, Younesi M, Altawallbeh G, Ghannoum MA, Bonfield T, Akkus O, Zender CA. Heparin-mediated antibiotic delivery from an electrochemically-aligned collagen sheet. Biomed Mater Eng 2021; 32:159-170. [PMID: 33780355 DOI: 10.3233/bme-201133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Implantable medical devices and hardware are prolific in medicine, but hardware associated infections remain a major issue. OBJECTIVE To develop and evaluate a novel, biologic antimicrobial coating for medical implants. METHODS Electrochemically compacted collagen sheets with and without crosslinked heparin were synthesized per a protocol developed by our group. Sheets were incubated in antibiotic solution (gentamicin or moxifloxacin) overnight, and in vitro activity was assessed with five-day diffusion assays against Pseudomonas aeruginosa. Antibiotic release over time from gentamicin-infused sheets was determined using in vitro elution and high performance liquid chromatography (HPLC). RESULTS Collagen-heparin-antibiotic sheets demonstrated larger growth inhibition zones against P. aeruginosa compared to collagen-antibiotic alone sheets. This activity persisted for five days and was not impacted by rinsing sheets prior to evaluation. Rinsed collagen-antibiotic sheets did not produce any inhibition zones. Elution of gentamicin from collagen-heparin-gentamicin sheets was gradual and remained above the minimal inhibitory concentration for gentamicin-sensitive organisms for 29 days. Conversely, collagen-gentamicin sheets eluted their antibiotic load within 24 hours. Overall, heparin-associated sheets demonstrated larger inhibition zones against P. aeruginosa and prolonged elution profile via HPLC. CONCLUSION We developed a novel, local antibiotic delivery system that could be used to coat medical implants/hardware in the future and reduce post-operative infections.
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Affiliation(s)
- Olivia T Cheng
- Case Western Reserve University (CWRU) School of Medicine, Cleveland, OH, USA
| | - Andrew P Stein
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Eric Babajanian
- Case Western Reserve University (CWRU) School of Medicine, Cleveland, OH, USA
| | - Kathryn R Hoppe
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Shawn Li
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Hyungjin Jung
- Department of Biomedical Engineering, CWRU, Cleveland, OH, USA
| | - Anish Abrol
- Department of Otolaryngology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Anna Akkus
- Department of Macromolecular Science & Engineering, CWRU, Cleveland, OH, USA
| | - Mousa Younesi
- Department of Biomedical Engineering, CWRU, Cleveland, OH, USA
| | | | - Mahmoud A Ghannoum
- Center for Medical Mycology, CWRU and University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | - Ozan Akkus
- Department of Biomedical Engineering, CWRU, Cleveland, OH, USA
| | - Chad A Zender
- Department of Otolaryngology, University of Cincinnati, Cincinnati, OH, USA
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Kheirallah M, Ozzo S. Morbidity of Teeth in Mandibular Fracture Lines - A Retrospective Study. Dent Traumatol 2018; 34:284-289. [PMID: 29869831 DOI: 10.1111/edt.12413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIM Teeth in mandibular fracture lines is common in maxillofacial trauma, but their retention or extraction is a matter of controversy. The aim of this study was to determine the factors related to retaining or extracting teeth situated in mandibular fracture lines and to decide the best treatment option. METHODS The study included 115 patients with a single mandibular fracture that had a tooth in the line of fracture. All patients were evaluated for complications and pulp status. Patient distribution was analyzed according to the complications that occurred. Statistical analysis was performed using SPSS 13.0 software. RESULTS There were significant effects of tooth type and tooth location on the occurrence of complications. There were no significant differences in the occurrence of complications between the retained teeth group and the extracted teeth group irrespective of age and gender in adult patients. There were significant differences in treatment procedures between the retained teeth group and the extracted teeth group. CONCLUSION Mandibular anterior teeth involved in the fracture line should be retained, while in the mandibular angle area, they should be extracted because retaining teeth in this region increases the prediction of complications. There is no role of pulp testing in the assessment of pulp status, but root canal treatment of retained teeth helps to reduce the occurrence of complications. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Mouetaz Kheirallah
- Maxillofacial Surgery Department College of Dentistry, Al-Andalus University for Medical Sciences, Al-Qadmous, The Syrian Arab Republic. Temporarily at Majma'ah University, KSA
| | - Sameer Ozzo
- Maxillofacial Surgery Department, College of Dental Medicine, Arab University of Science & Technology, Hama, Syrian Arab Republic
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Alsharif U, Al-Moraissi E, Alabed S. Systemic antibiotic prophylaxis for preventing infectious complications in maxillofacial trauma surgery. Hippokratia 2017. [DOI: 10.1002/14651858.cd012603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ubai Alsharif
- Charite-Universitatsmedizin Berlin; Chariteplatz 1 Berlin Germany 10117
| | - Essam Al-Moraissi
- Thamar University; Department of Oral and Maxillofacial Surgery; Radaa Street Thamar Thamar Yemen
| | - Samer Alabed
- University of Sheffield; Academic Unit of Radiology; Sheffield UK
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Boyd SE, Charani E, Lyons T, Frost G, Holmes AH. Information provision for antibacterial dosing in the obese patient: a sizeable absence? J Antimicrob Chemother 2016; 71:3588-3592. [PMID: 27538956 DOI: 10.1093/jac/dkw324] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 07/04/2016] [Accepted: 07/12/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Obesity is on course to overtake being underweight as a global disease burden. Obesity alters antibacterial pharmacokinetics (PK) and pharmacodynamics (PD). Historically, drug PK/PD parameters have not been studied in obese populations. This means dose recommendations risk being sub-therapeutic in a population at increased risk of infection. Suboptimal antibacterial prescribing is widely associated with treatment failure, worse clinical outcomes, unnecessary escalation to broad-spectrum therapy and the emergence of antimicrobial resistance (AMR). OBJECTIVES To analyse current information provided by pharmaceutical companies, for the most commonly prescribed antibacterial agents in the UK, for evidence of dosing guidance for obese adults. METHODS We analysed the manufacturers' Summary of Product Characteristics (SPC) for 42 of the most clinically important and frequently prescribed antibacterial agents dispensed across both primary and secondary care. The manufacturer's SPC was reviewed, and cross-referenced with the online British National Formulary, to assess dosing guidance for obese adults. RESULTS No advice was provided to guide dosing for obese adults in 35 (83%) of 42 of the most clinically important and frequently prescribed antibacterial agents in the UK. Seven (17%) antibacterial agents (tigecycline, vancomycin, daptomycin, amikacin, gentamicin, tobramycin and teicoplanin) provided variable levels of advice. CONCLUSIONS There is a paucity of advice and evidence in the UK to guide dosing common antibacterial agents in the obese. The literature on antibacterial PK/PD studies in obese populations remains scarce. In the face of the increasing risks of AMR combined with the global rise of obesity there is an urgent need to address this significant research gap.
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Affiliation(s)
- Sara Elizabeth Boyd
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London W12 0NN, UK .,Imperial College Healthcare NHS Trust, London, UK
| | - Esmita Charani
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London W12 0NN, UK
| | - Tracy Lyons
- Imperial College Healthcare NHS Trust, London, UK
| | - Gary Frost
- Department of Medicine, Imperial College London, Hammersmith Campus, London W12 0NN, UK
| | - Alison Helen Holmes
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London W12 0NN, UK.,Imperial College Healthcare NHS Trust, London, UK
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