Antimicrobial Susceptibility of Moxifloxacin Against Gram-Negative Enteric Rods From Colombian Patients With Chronic Periodontitis

Clinical and Microbiological Efficacy of Adjunctive Systemic Quinolones to Mechanical Therapy in Periodontitis: A Systematic Review of the Literature

Objectives

To assess the clinical and microbiological efficacy of systemic quinolones adjunctive to mechanical therapy in periodontitis patients. Materials and Methods. A systematic review of the scientific literature was carried out. The search scheme comprised the Scopus, PubMed/MEDLINE, SCIELO (Scientific Electronic Library Online), and LILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud) databases, together with the gray literature. MeSH terms and keywords were utilized to explore publications in all idioms. Only randomized clinical trials (RCTs) that met the selection criteria were included.

Results

A total of 4 RCTs were selected. These RCTs found superior clinical and microbiological efficacy of adjunctive systemic moxifloxacin (MOX) and levofloxacin (LV) compared to subgingival debridement plus placebo. Improvements in PD and CAL were 2.4 ± 0.8 mm and 2.7 ± 0.9 mm for LV, and 1.5 ± 0.5 mm and 1.8 ± 0.5 mm for MOX, respectively. After six months of follow-up, adjunctive MOX reduced the presence of Aggregatibacter actinomycetemcomitans to imperceptible levels, while LV markedly reduced this microorganism. Some adverse events were reported in the LV group and none in the MOX group.

Conclusions

Adjunctive MOX and LV improve probing depth and clinical attachment level compared with subgingival debridement alone in patients with periodontitis. The efficacy of these quinolones against A. actinomycetemcomitans was also superior.

Opportunistic pathogens are associated with deteriorated clinical parameters in peri-implant disease

OBJECTIVES

To assess the association between Gram-negative enteric rods and Pseudomonas with the clinical parameters in peri-implant disease.

MATERIALS AND METHODS

Patients treated with implants and diagnosed with peri-implant mucositis and/or peri-implantitis participate in this cross-sectional research. Unusual microorganisms from the implants were recognized using MALDI-TOF mass spectrometry. Linear regression models were applied.

RESULTS

A total of 103 implants were evaluated in thirty-one participants. Gram-negative enteric rods/Pseudomonas were observed in 47 implants (46%). Interestingly, there were differences in probing pocket depth (PPD), clinical attachment loss (CA), and bleeding on probing (BOP) between the groups, where implants with the presence of Gram-negative enteric rods/Pseudomonas presented deteriorated clinical parameters (p < .0001). The crude and adjusted linear regression models for PPD in peri-implant mucositis, PPD in peri-implantitis, CA in peri-implantitis, and BOP in peri-implant disease present significant βs, demonstrating deteriorated parameters (p < .0001) in the presence of Gram-negative enteric rods/Pseudomonas. Besides, the model for CA in peri-implantitis showed that cemented restored reconstructions were statistically significant (p = .009). Additionally, the R2 value in most models indicated a high degree of correlation (>85%).

CONCLUSION

The occurrence of Gram-negative enteric rods and Pseudomonas was associated with deteriorated clinical parameters in patients with peri-implant disease.

Gram-negative enteric rods/Pseudomonas colonization in mucositis and peri-implantitis of implants restored with cemented and screwed reconstructions: A cross-sectional study

PURPOSE

To evaluate the association between Gram-negative enteric rods and Pseudomonas with mucositis and peri-implantitis, in implants restored with cemented and screw-retained reconstructions.

MATERIALS AND METHODS

Individuals treated with implants, diagnosed with peri-implant mucositis and or peri-implantitis, participated in this study. Microbiota from the implant and the gingival sulcus of two neighboring teeth were also studied. The microorganisms were identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry.

RESULTS

A total of 52 and 51 implants cemented and screwed restored were evaluated in 31 patients. The presence of Gram-negative enteric rods/Pseudomonas (P = .01) was significantly higher in the cemented restored implants. When the unit of analysis was the implant, the presence of Gram-negative enteric rods/Pseudomonas was associated with cemented restored implants after adjustment for possible confounders (odds ratio [OR] = 3.7; 95% CI, 1.4-10; P = .01); besides, peri-implantitis was statistically significant in the multivariate model (P = .008). Considering the patient as a unit of analysis, peri-implantitis was associated with cemented restored implants (OR = 9.4; 95% CI, 2-46; P = .006); this statistically significant association remained after adjusting for potential confounders (OR = 6.8; 95% CI, 1.3-37; P = .02).

CONCLUSION

The presence of Gram-negative enteric rods/Pseudomonas was associated with cemented restored implants; besides, peri-implantitis was associated with cemented restored implants.

Hydrophobicity of graphene as a driving force for inhibiting biofilm formation of pathogenic bacteria and fungi

OBJECTIVE

To evaluate the surface and wettability characteristics and the microbial biofilm interaction of graphene coating on titanium.

METHODS

Graphene was deposited on titanium (Control) via a liquid-free technique. The transfer was performed once (TiGS), repeated two (TiGD) and five times (TiGV) and characterized by AFM (n=10), Raman spectroscopy (n=10), contact angle and SFE (n=5). Biofilm formation (n=3) to Streptococcus mutans, Enterococcus faecalis, Pseudomonas aeruginosa and Candida albicans was evaluated after 24h by CV assay, CFU, XTT and confocal microscopy. Statistics were performed by one-way Anova, Tukey's tests and Pearson's correlation analysis at a pre-set significance level of 5 %.

RESULTS

Raman mappings revealed coverage yield of 82 % for TiGS and ≥99 % for TiGD and TiGV. Both TiGD and TiGV presented FWHM>44cm^-1 and I_D/I_G ratio<0.12, indicating multiple graphene layers and occlusion of defects. The contact angle was significantly higher for TiGD and TiGV (110° and 117°) comparing to the Control (70°). The SFE was lower for TiGD (13.8mN/m) and TiGV (12.1mN/m) comparing to Control (38.3mN/m). TiGD was selected for biofilm assays and exhibited significant reduction in biofilm formation for all microorganisms compared to Control. There were statistical correlations between the high contact angle and low SFE of TiGD and decreased biofilm formation.

SIGNIFICANCE

TiGD presented high quality and coverage and decreased biofilm formation for all species. The increased hydrophobicity of graphene films was correlated with the decreased biofilm formation for various species.

Application of diverse natural polymers in the design of oral gels for the treatment of periodontal diseases

The objective of this study was to prepare periodontal gels using natural polymers such as badam gum, karaya gum and chitosan. These gels were tested for their physical and biochemical properties and assessed for their antibacterial activity against Aggregatibacter actinomycetemcomitans and Streptococcus mutans, two pathogens associated with periodontal disease. Badam gum, karaya gum and chitosan were used to prepare gels of varying concentrations. Moxifloxacin hydrochloride, a known antimicrobial drug was choosen in the present study and it was added to the above gels. The gels were then run through a battery of tests in order to determine their physical properties such as pH and viscosity. Diffusion studies were carried out on the gels containing the drug. Antimicrobial testing of the gels against various bacteria was then carried out to determine the effectiveness of the gels against these pathogens. The results showed that natural polymers can be used to produce gels. These gels do not have inherent antimicrobial properties against A. actinomycetemcomitans and S. mutans. However, they can be used as a transport vehicle to carry and release antimicrobial drugs.

Systemic antibiotics in the treatment of periodontitis

Despite the fact that several clinical studies have shown additional benefits when certain systemic antibiotics are used as adjuncts to periodontal treatment, clear guidelines for the use of these agents in the clinical practice are not yet available. Basic questions concerning the use of systemic antibiotics to treat periodontitis remain unanswered, such as: which drug(s) should be used; which patients would most benefit from treatment; which are the most effective protocols (i.e. doses and durations); and in which phase of the mechanical therapy should the drug(s) be administered? Although not all of those questions have been directly addressed by controlled randomized clinical trials, recent concepts related to the ecology of periodontal diseases, as well as the major advances in laboratory and clinical research methods that have occurred in the past decade, have significantly broadened our knowledge in this field. This article endeavored to provide a 'state of the art' overview on the use of systemic antibiotics in the treatment of periodontitis, based on the most recent literature on the topic as well as on a compilation of data from studies conducted at the Center of Clinical Trials at Guarulhos University (São Paulo, Brazil) from 2002 to 2012.

Microbial signatures of oral dysbiosis, periodontitis and edentulism revealed by Gene Meter methodology

Conceptual models suggest that certain microorganisms (e.g., the "red" complex) are indicative of a specific disease state (e.g., periodontitis); however, recent studies have questioned the validity of these models. Here, the abundances of 500+ microbial species were determined in 16 patients with clinical signs of one of the following oral conditions: periodontitis, established caries, edentulism, and oral health. Our goal was to determine if the abundances of certain microorganisms reflect dysbiosis or a specific clinical condition that could be used as a 'signature' for dental research. Microbial abundances were determined by the analysis of 138,718 calibrated probes using Gene Meter methodology. Each 16S rRNA gene was targeted by an average of 194 unique probes (n=25nt). The calibration involved diluting pooled gene target samples, hybridizing each dilution to a DNA microarray, and fitting the probe intensities to adsorption models. The fit of the model to the experimental data was used to assess individual and aggregate probe behavior; good fits (R²>0.90) were retained for back-calculating microbial abundances from patient samples. The abundance of a gene was determined from the median of all calibrated individual probes or from the calibrated abundance of all aggregated probes. With the exception of genes with low abundances (<2 arbitrary units), the abundances determined by the different calibrations were highly correlated (r~1.0). Seventeen genera were classified as 'signatures of dysbiosis' because they had significantly higher abundances in patients with periodontitis and edentulism when contrasted with health. Similarly, 13 genera were classified as 'signatures of periodontitis', and 14 genera were classified as 'signatures of edentulism'. The signatures could be used, individually or in combination, to assess the clinical status of a patient (e.g., evaluating treatments such as antibiotic therapies). Comparisons of the same patient samples revealed high false negatives (45%) for next-generation-sequencing results and low false positives (7%) for Gene Meter results.

Non-oral gram-negative facultative rods in chronic periodontitis microbiota

OBJECTIVE

The subgingival prevalence of gram-negative facultative rods not usually inhabiting or indigenous to the oral cavity (non-oral GNFR), as well as selected periodontal bacterial pathogens, were evaluated by culture in untreated and treated chronic periodontitis patients.

METHODS

Subgingival biofilm specimens from 102 untreated and 101 recently treated adults with chronic periodontitis in the Netherlands were plated onto MacConkey III and Dentaid selective media with air-5% CO2 incubation for isolation of non-oral GNFR, and onto enriched Oxoid blood agar with anaerobic incubation for recovery of selected periodontal bacterial pathogens. Suspected non-oral GNFR clinical isolates were identified to a species level with the VITEK 2 automated system.

RESULTS

A total of 87 (42.9%) out of 203 patients yielded subgingival non-oral GNFR. Patients recently treated with periodontal mechanical debridement therapy demonstrated a greater prevalence of non-oral GNFR (57.4% vs 28.4%, P < 0.0001), and a greater number of different non-oral GNFR species (23 vs 14 different species), than untreated patients. Sphingomonas paucimobilis was the most frequently isolated subgingival non-oral GNFR species. Several GNFR species normally found in animals and human zoonotic infections, and not previously detected in human subgingival biofilms, were recovered from some patients, including Bordetella bronchispetica, Pasteurella canis, Pasteurella pneumotropica and Neisseria zoodegmatis. Porphyromonas gingivalis and Tannerella forsythia were significantly associated with the presence of subgingival non-oral GNFR.

CONCLUSIONS

A surprisingly high proportion of Dutch chronic periodontitis patients yielded cultivable non-oral GNFR in periodontal pockets, particularly among those recently treated with periodontal mechanical debridement therapy. Since non-oral GNFR species may resist mechanical debridement from periodontal pockets, and are often not susceptible to many antibiotics frequently used in periodontal practice, their subgingival presence may complicate periodontal treatment in species-positive patients and increase risk of potentially dangerous GNFR infections developing at other body sites.

Microbial profiles at baseline and not the use of antibiotics determine the clinical outcome of the treatment of chronic periodontitis

Antibiotics are often used in the treatment of chronic periodontitis, which is a major cause of tooth loss. However, evidence in favour of a microbial indication for the prescription of antibiotics is lacking, which may increase the risk of the possible indiscriminate use of antibiotics, and consequent, microbial resistance. Here, using an open-ended technique, we report the changes in the subgingival microbiome up to one year post-treatment of patients treated with basic periodontal therapy with or without antibiotics. Antibiotics resulted in a greater influence on the microbiome 3 months after therapy, but this difference disappeared at 6 months. Greater microbial diversity, specific taxa and certain microbial co-occurrences at baseline and not the use of antibiotics predicted better clinical treatment outcomes. Our results demonstrate the predictive value of specific subgingival bacterial profiles for the decision to prescribe antibiotics in the treatment of periodontitis, but they also indicate the need for alternative therapies based on ecological approaches.

Relationship between Gram negative enteric rods, Aggregatibacter actinomycetemcomitans, and clinical parameters in periodontal disease

BACKGROUND

The association between Gram negative enteric rods and Aggregatibacter actinomycetemcomitans in periodontal diseases has received little attention in the literature. The objective of this study was to explore the relationship between these organisms and clinical parameters of periodontal disease.

MATERIALS AND METHODS

Clinical parameters and occurrence of Gram-negative enteric rods and A. actinomycetemcomitans were examined in 76 patients with chronic periodontitis. Chi-square and Mann-Whitney tests were used to determine differences in clinical variables versus the presence or absence of both microorganisms. Correlation among both organisms and clinical data were determined using Spearman rank correlation coefficient.

RESULTS

Gram-negative enteric rods and A. actinomycetemcomitans were detected in 20 (26.3%) and 18 (23.7%) individuals, respectively. A total of 14 (18.4%) patients harbored both microorganisms studied. There were significantly positive correlations between enteric rods and presence of A. actinomycetemcomitans (r=0.652, P<0.0001). Both microorganisms were significant and positively correlated with probing depth (PD), clinical attachment level, and bleeding on probing (P<0.0001). The mean PD (mm) of the sampled sites was significantly deeper in patients with presence of A. actinomycetemcomitans and Gram-negative enteric rods.

CONCLUSION

The results of the present study suggest a strong positive correlation between Gram-negative enteric rods and A. actinomycetemcomitans in the population studied. This finding must be taken into account when considering the best therapeutic approach, including the utilization of antimicrobials. The adverse clinical outcomes observed in presence of these microorganisms could have implications in the pathogenesis of periodontal disease and a possible impact on outcomes after treatment.