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Benwan KA, Jamal W, Shahin M. Third Kuwaiti Multicenter Survey of Antibiotic Susceptibility of Anaerobic Bacteria: A Comparative Analysis of 20-Year Data. Microb Drug Resist 2024; 30:372-384. [PMID: 39250785 DOI: 10.1089/mdr.2024.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024] Open
Abstract
Objective: This study aimed to evaluate antibiotic susceptibility and antimicrobial resistance trends among clinically significant anaerobes in Kuwait hospitals from 2013 to 2022, comparing these findings with data from 2002 to 2012. Methods: The study prospectively collected 2,317 anaerobic isolates from various body sites across four Kuwaiti hospitals between January 2013 and December 2022. The minimum inhibitory concentrations for 11 antianaerobic antibiotics were determined using E-test methodology. The study analyzed trends and resistance rates across two periods: 2013-2017 and 2018-2022, using statistical analysis for resistance comparison. Results: Of the 2,317 isolates, most were from wounds (42.2%), fluids (28.0%), and tissues (20.5%). Bacteroides fragilis was the most common pathogen (34.0%), followed by Prevotella bivia (13.4%). Over 90% of isolates were susceptible to imipenem, meropenem, tigecycline, and metronidazole, whereas lower susceptibility was observed for penicillin, amoxicillin-clavulanic acid, and clindamycin. Notable differences in resistance profiles since 2002 were observed, especially in amoxicillin-clavulanic acid, piperacillin, piperacillin-tazobactam, and clindamycin. Conclusion: Owing to detected resistance to all antibiotics, susceptibility testing for anaerobic isolates is recommended in severe infections to ensure effective antimicrobial therapy. Continuous surveillance is crucial for developing antibiotic policies to manage invasive anaerobic infections.
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Affiliation(s)
- Khalifa Al Benwan
- Department of Microbiology, College of Medicine, Kuwait University, Safat, Kuwait
| | - Wafaa Jamal
- Department of Microbiology, College of Medicine, Kuwait University, Safat, Kuwait
| | - May Shahin
- Department of Microbiology, College of Medicine, Kuwait University, Safat, Kuwait
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2
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Lomakin IB, Devarkar SC, Grada A, Bunick CG. Mechanistic Basis for the Translation Inhibition of Cutibacterium acnes by Clindamycin. J Invest Dermatol 2024:S0022-202X(24)01975-4. [PMID: 39122144 DOI: 10.1016/j.jid.2024.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/11/2024] [Accepted: 07/13/2024] [Indexed: 08/12/2024]
Abstract
Inflammation and the Gram-positive anaerobic bacterium Cutibacterium acnes, which is implicated in acne pathogenesis and pilosebaceous-unit inflammation, are the main targets of antibiotic-based therapy against acne vulgaris (acne). The most widely used antibiotics in acne therapy are tetracyclines, macrolides, and lincosamides. Unfortunately, C. acnes bacteria over the past several decades have demonstrated increased resistance to these antibiotics, particularly to clindamycin. The precise knowledge of how antibiotics interact with their clinical target is needed to overcome this problem. Toward this goal, we determined the structure of clindamycin in complex with the ribosome of C. acnes at 2.53 Å resolution using cryogenic electron microscopy. The galactose sugar moiety of clindamycin interacts with nucleotides of the 23S ribosomal RNA directly or through a conserved network of water-mediated interactions. Its propyl pyrrolidinyl group interacts with the 23S ribosomal RNA through van der Waals forces. Clindamycin binding to the C. acnes ribosome interferes with both: proper orientation of the aminoacyl group of the A-site bound transfer RNA that is needed for peptide bond formation and with the extension of the nascent peptide. Our data are important for advancing the understanding of antibiotic resistance and development of narrow-spectrum antibacterial drugs, which is an urgent need for contemporary antibiotic stewardship.
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Affiliation(s)
- Ivan B Lomakin
- Department of Dermatology, Yale University, New Haven, Connecticut, USA.
| | - Swapnil C Devarkar
- Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, Connecticut, USA
| | - Ayman Grada
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Christopher G Bunick
- Department of Dermatology, Yale University, New Haven, Connecticut, USA; Program in Translational Biomedicine, Yale University School of Medicine, New Haven, Connecticut, USA.
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3
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Kaya S, Bedir O, Baysallar M, Ören S, Koru Ö, Albay A. Rapid detection of antimicrobial susceptibility of the Bacteroides fragilis group by flow cytometry: A preliminary study. Diagn Microbiol Infect Dis 2024; 110:116464. [PMID: 39180786 DOI: 10.1016/j.diagmicrobio.2024.116464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 07/12/2024] [Accepted: 07/22/2024] [Indexed: 08/26/2024]
Abstract
A total of nine Bacteroides fragilis group strains and B. fragilis ATCC 25285 were studied. Six antibiotics were used in the study. Broth dilution method was used for flow cytometry (FCM) analysis. Cell suspensions with antibiotics and antibiotic-free were stained with thiazole orange and propidium iodide (PI) to differentiate dead/live cells. The percentage of dead and live cells was calculated using FCM device. Cut-off values for antibiotics (26,7 %, 35,5 % and 30,2 % for meropenem, AMC and clindamycin, respectively) were calculated for dead/live cell differentiation. A common cut-off value was calculated for bactericidal and bacteriostatic (31,8 % and 25,7 % respectively). The PI staining ratios of the B. fragilis ATCC 25285 calculated in the MIC ranges for each antibiotic were under the cut-off values calculated with clinical isolates. The cut-off values we calculated are compatible with MBC rather than MIC values. The FCM method is one of the candidate methods for antimicrobial susceptibility testing.
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Affiliation(s)
- Sinem Kaya
- Department of Medical Microbiology, Gulhane Training and Research Hospital, Etlik, Ankara, Turkey.
| | - Orhan Bedir
- Department of Medical Microbiology, Gulhane Medical Faculty, University of Health Sciences, Etlik, Ankara, Turkey
| | - Mehmet Baysallar
- Department of Medical Microbiology, Gulhane Medical Faculty, University of Health Sciences, Etlik, Ankara, Turkey
| | - Sema Ören
- Molecular Application and Research Unit of R and D Laboratory, University of Health Sciences, Etlik, Ankara, Turkey
| | - Özgür Koru
- Department of Medical Microbiology, Gulhane Medical Faculty, University of Health Sciences, Etlik, Ankara, Turkey
| | - Ali Albay
- Department of Medical Microbiology, Gulhane Medical Faculty, University of Health Sciences, Etlik, Ankara, Turkey
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Mori N, Nakamura A, Hirai J, Asai N, Shibata Y, Takayama M, Kawamoto Y, Miyazaki N, Sakanashi D, Ohno T, Yamada A, Suematsu H, Koita I, Chida S, Ohta T, Mikamo H. Clinical characteristics and antimicrobial susceptibility of Fusobacterium species isolated over 10 years at a Japanese university hospital. Eur J Clin Microbiol Infect Dis 2024; 43:423-433. [PMID: 38112966 DOI: 10.1007/s10096-023-04734-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/02/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE Anaerobic bacteria, existing on human skin and mucous membranes, can cause severe infections with complications or mortality. We examined the clinical characteristics of patients infected with Fusobacterium spp. and assessed their antibiotic susceptibility. METHODS Clinical data were collated from patients diagnosed with Fusobacterium infections in a Japanese university hospital between 2014 and 2023. Antibiotic susceptibility tests were conducted following the Clinical and Laboratory Standards Institute guidelines. RESULTS We identified 299 Fusobacterium isolates. The median age was 61 years (range, 14-95 years), with females constituting 43.1% of the patients. Most infections were community-acquired (84.6%, 253/299). Multiple bacterial strains were isolated simultaneously in 74.6% of cases. One-fourth of the patients had solid organ malignancies (25.4%, 76/299), and 14.5% (11/76) of those had colorectal cancer. The 30-day mortality rate was 1.3%. Fusobacterium species were isolated from blood cultures in 6% (18/299) of the patients. Patients, aged 75 years or older, with cerebrovascular disease or hematologic malignancy exhibited significantly higher prevalence of blood culture isolates in univariate analysis. Each Fusobacterium species had its characteristic infection site. Approximately 5% F. nucleatum and F. necrophorum isolates showed penicillin G resistance. Moxifloxacin resistance was observed in varying degrees across strains, ranging from 4.6 to 100% of isolates. All isolates were sensitive to β-lactam/β-lactamase inhibitors, carbapenems, and metronidazole. CONCLUSION We show a link between Fusobacterium species and solid organ malignancies. We observed resistance to penicillin, cefmetazole, clindamycin, and moxifloxacin, warranting caution in their clinical use. This study offers valuable insights for managing Fusobacterium infections and guiding empirical treatments.
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Affiliation(s)
- Nobuaki Mori
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1 Yazakokarimata Nagakute-Shi, Aichi, 480-1195, Japan
- Department of Infection Prevention and Control, Aichi Medical University Hospital, 1-1 Yazakokarimata Nagakute-Shi, Aichi, 480-1195, Japan
| | - Akiko Nakamura
- Department of Infection Prevention and Control, Aichi Medical University Hospital, 1-1 Yazakokarimata Nagakute-Shi, Aichi, 480-1195, Japan
| | - Jun Hirai
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1 Yazakokarimata Nagakute-Shi, Aichi, 480-1195, Japan
- Department of Infection Prevention and Control, Aichi Medical University Hospital, 1-1 Yazakokarimata Nagakute-Shi, Aichi, 480-1195, Japan
| | - Nobuhiro Asai
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1 Yazakokarimata Nagakute-Shi, Aichi, 480-1195, Japan
- Department of Infection Prevention and Control, Aichi Medical University Hospital, 1-1 Yazakokarimata Nagakute-Shi, Aichi, 480-1195, Japan
| | - Yuichi Shibata
- Department of Infection Prevention and Control, Aichi Medical University Hospital, 1-1 Yazakokarimata Nagakute-Shi, Aichi, 480-1195, Japan
| | - Mina Takayama
- Department of Infection Prevention and Control, Aichi Medical University Hospital, 1-1 Yazakokarimata Nagakute-Shi, Aichi, 480-1195, Japan
| | - Yuzuka Kawamoto
- Department of Infection Prevention and Control, Aichi Medical University Hospital, 1-1 Yazakokarimata Nagakute-Shi, Aichi, 480-1195, Japan
| | - Narimi Miyazaki
- Department of Infection Prevention and Control, Aichi Medical University Hospital, 1-1 Yazakokarimata Nagakute-Shi, Aichi, 480-1195, Japan
| | - Daisuke Sakanashi
- Department of Infection Prevention and Control, Aichi Medical University Hospital, 1-1 Yazakokarimata Nagakute-Shi, Aichi, 480-1195, Japan
| | - Tomoko Ohno
- Department of Infection Prevention and Control, Aichi Medical University Hospital, 1-1 Yazakokarimata Nagakute-Shi, Aichi, 480-1195, Japan
| | - Atsuko Yamada
- Department of Infection Prevention and Control, Aichi Medical University Hospital, 1-1 Yazakokarimata Nagakute-Shi, Aichi, 480-1195, Japan
| | - Hiroyuki Suematsu
- Department of Infection Prevention and Control, Aichi Medical University Hospital, 1-1 Yazakokarimata Nagakute-Shi, Aichi, 480-1195, Japan
| | - Isao Koita
- Department of Infection Prevention and Control, Aichi Medical University Hospital, 1-1 Yazakokarimata Nagakute-Shi, Aichi, 480-1195, Japan
| | - Sumie Chida
- Department of Infection Prevention and Control, Aichi Medical University Hospital, 1-1 Yazakokarimata Nagakute-Shi, Aichi, 480-1195, Japan
| | - Toshiaki Ohta
- Department of Infection Prevention and Control, Aichi Medical University Hospital, 1-1 Yazakokarimata Nagakute-Shi, Aichi, 480-1195, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1 Yazakokarimata Nagakute-Shi, Aichi, 480-1195, Japan.
- Department of Infection Prevention and Control, Aichi Medical University Hospital, 1-1 Yazakokarimata Nagakute-Shi, Aichi, 480-1195, Japan.
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Salam R, Verma A, Noeske M, Alnimer L, Sieloff EM, Piper MS. Gastrointestinal Variant of Lemierre Syndrome due to Fusobacterium nucleatum: A Case Report. Case Rep Gastroenterol 2024; 18:144-152. [PMID: 38501151 PMCID: PMC10948173 DOI: 10.1159/000536619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 01/29/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction Pyogenic liver abscess is a noteworthy health concern in North America, characterized by a mortality rate ranging from 2 to 12%. This condition is often polymicrobial, with Streptococcus species and Escherichia coli as the predominant causal pathogens in Western countries. Fusobacterium species, typically commensals of gastrointestinal, genital, and oral flora, have been implicated in the rare formation of tonsillar abscesses and Lemierre syndrome, including its gastrointestinal variant known as pylephlebitis. Case Presentation We present the case of an immunocompetent male with a 2-week history of abdominal distention and pain. Abdominal magnetic resonance imaging revealed multiseptated cystic hepatic masses and portal vein thrombosis. A subsequent liver biopsy confirmed Fusobacterium nucleatum etiology. The patient was initiated on intravenous cefepime and oral metronidazole antibiotics. Unfortunately, the patient succumbed to cardiac arrest before a final diagnosis could be established. Conclusion Fusobacterium species-associated liver abscess, coupled with the rare gastrointestinal variant of Lemierre syndrome (pylephlebitis), poses a significant mortality risk. This case underscores the rarity and clinical challenges associated with these conditions. Increased awareness among clinicians is crucial for early diagnosis and prompt intervention, potentially improving outcomes in such cases.
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Affiliation(s)
- Reshad Salam
- Department of Internal Medicine, Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI, USA
| | - Abhiroop Verma
- Department of Internal Medicine, Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI, USA
| | - Michael Noeske
- Division of Radiology, Metrohealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Lynna Alnimer
- Department of Internal Medicine, Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI, USA
| | - Eric M. Sieloff
- Division of Gastroenterology, Department of Internal Medicine, Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI, USA
| | - Marc S. Piper
- Division of Gastroenterology, Department of Internal Medicine, Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI, USA
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Rams TE, Sautter JD, van Winkelhoff AJ. Emergence of Antibiotic-Resistant Porphyromonas gingivalis in United States Periodontitis Patients. Antibiotics (Basel) 2023; 12:1584. [PMID: 37998786 PMCID: PMC10668829 DOI: 10.3390/antibiotics12111584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 11/25/2023] Open
Abstract
Antibiotic resistance patterns of the major human periodontal pathogen Porphyromonas gingivalis were assessed over a 20-year period in the United States. Subgingival P. gingivalis was cultured pre-treatment from 2193 severe periodontitis patients during three time periods: 1999-2000 (936 patients), 2009-2010 (685 patients), and 2019-2020 (572 patients). The clinical isolates were tested for in vitro resistance to 4 mg/L for clindamycin and doxycycline, 8 mg/L for amoxicillin, and 16 mg/L for metronidazole, with a post hoc combination of data for metronidazole plus amoxicillin. Clindamycin-resistant P. gingivalis was significantly more prevalent in 2009-2010 (9.1% of patients) and 2019-2020 (9.3%; 15-fold increase) as compared to 1999-2000 (0.6%). P. gingivalis resistance to amoxicillin also significantly increased from 0.1% of patients in 1999-2000 to 1.3% in 2009-2010 and 2.8% (28-fold increase) in 2019-2020. P. gingivalis resistance to metronidazole, metronidazole plus amoxicillin, and doxycycline was low (≤0.5% prevalence), and statistically unchanged, over the 20-year period. These findings are the first to reveal marked increases over 20 years in clindamycin-resistant and amoxicillin-resistant P. gingivalis in United States periodontitis patients. Increased antibiotic resistance of P. gingivalis and other periodontitis-associated bacteria threatens the efficacy of periodontal antimicrobial chemotherapy.
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Affiliation(s)
- Thomas E. Rams
- Department of Periodontology and Oral Implantology, Temple University School of Dentistry, Philadelphia, PA 19140, USA;
| | - Jacqueline D. Sautter
- Department of Periodontology and Oral Implantology, Temple University School of Dentistry, Philadelphia, PA 19140, USA;
| | - Arie J. van Winkelhoff
- Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
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Sevillano G, Paz Y Miño A, Solís MB, Vaca JP, Zurita-Salinas C, Zurita J. First Report of Antibiotic Resistance Markers cfiA and nim Among Bacteroides fragilis Group Strains in Ecuadorian Patients. Microb Drug Resist 2023; 29:533-539. [PMID: 37733248 DOI: 10.1089/mdr.2023.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
In recent years, increasing resistance of Bacteroides fragilis to several antibiotics has been reported in different countries. The aim of this study was to evaluate the antibiotic resistance profiles of Bacteroides spp. isolated from clinical samples by phenotypic and molecular methods. A total of 40 nonrepetitive isolates of the B. fragilis group were studied from 2018 to 2019. The species was identified by API 20A system. The minimum inhibitory concentrations (MICs) were determined by Sensititre anaerobe MIC plate. The presence of the nim and cfiA genes was checked by conventional PCR. The association between genes and insertion sequence (IS) was performed by whole genome sequencing. Eleven isolates were categorized as metronidazole-resistant and only 2 isolates harbored the nim gene. Five isolates were imipenem-resistant, but cfiA gene was detected in two isolates. cfiA gene was closely related to the cfiA-4 allele and associated with IS614B. The nim gene was not related to any nim gene type and was considered a new variant named nimL. IS612 was found upstream of nimL gene. In view of the scarcity of data on B. fragilis, there is a need to surveil antibiotic resistance levels and molecular mechanisms to implement better antimicrobial therapies against this important group of bacteria.
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Affiliation(s)
- Gabriela Sevillano
- Unidad de Investigaciones en Biomedicina, Zurita & Zurita Laboratorios, Quito, Ecuador
| | - Ariane Paz Y Miño
- Unidad de Investigaciones en Biomedicina, Zurita & Zurita Laboratorios, Quito, Ecuador
| | - María Belén Solís
- Unidad de Investigaciones en Biomedicina, Zurita & Zurita Laboratorios, Quito, Ecuador
| | - Juan Pablo Vaca
- Carrera de Ingeniería en Biotecnología, Departamento de Ciencias de la Vida, Universidad de las Fuerzas Armadas-ESPE, Sangolquí, Ecuador
| | - Camilo Zurita-Salinas
- Unidad de Investigaciones en Biomedicina, Zurita & Zurita Laboratorios, Quito, Ecuador
- Cátedra de Inmunología, Carrera de Medicina, Universidad Central del Ecuador, Quito, Ecuador
| | - Jeannete Zurita
- Unidad de Investigaciones en Biomedicina, Zurita & Zurita Laboratorios, Quito, Ecuador
- Pontificia Universidad Católica del Ecuador, Quito, Ecuador
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Kövér Z, Johansen Nordskag V, Bán Á, Gajdács M, Urbán E. The role of Actinomyces spp. and related organisms in cervicofacial infections: Pathomechanism, diagnosis and therapeutic aspects. Anaerobe 2023; 82:102767. [PMID: 37482285 DOI: 10.1016/j.anaerobe.2023.102767] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/26/2023] [Accepted: 07/20/2023] [Indexed: 07/25/2023]
Abstract
Members of the Actinomyces genus and Actinomyces-like organisms (ALOs; namely Actinotignum, Arcanobacterium, Schaalia and Varibaculum) are Gram-positive, non-spore-forming rods that are commensal members of the human oral cavity, gastrointestinal tract, female genital tract and skin microbiota. Cervicofacial actinomycosis or "lumpy jaw syndrome" - the chronic, suppurative granulomatous disease caused by Actinomyces spp. And ALOs - is characterized by an initially slow and unspecific disease-presentation, which often mimics other pathologies, followed by the formation of painful abscesses and severe tissue destruction. Actinomycosis has been described as a rare disease, however, reliable epidemiological data are lacking. In addition, there is increasing awareness regarding the role of Actinomyces spp. in the development of osteoradionecrosis and medication-related osteonecrosis of the jaw. The aim of this narrative review is to succinctly summarize the current advances regarding the microbiological, clinical, diagnostic and therapeutic aspects of cervicofacial actinomycosis, in addition to the roles of Actinomyces species and ALOs as members of the oral microbiota and in dental biofilm, in other dental infections (caries, root canal infection, periapical infection, periodontitis) and osteonecrosis of the jaw, in the context of recent taxonomic changes affecting the genus. Our paper aims to be a blueprint for dentists, other physicians, microbiologists and researchers regarding the multifaceted field of cervicofacial actinomycosis.
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Affiliation(s)
- Zsanett Kövér
- Department of Dentistry, Oral and Maxillofacial Surgery, Medical School, University of Pécs, Tüzér U. 1., 7623, Pécs, Hungary.
| | - Vidar Johansen Nordskag
- Department of Dentistry, Oral and Maxillofacial Surgery, Medical School, University of Pécs, Tüzér U. 1., 7623, Pécs, Hungary.
| | - Ágnes Bán
- Department of Dentistry, Oral and Maxillofacial Surgery, Medical School, University of Pécs, Tüzér U. 1., 7623, Pécs, Hungary.
| | - Márió Gajdács
- Department of Oral Biology and Experimental Dental Research, Faculty of Dentistry, University of Szeged, Tisza Lajos krt. 64-66., 6725, Szeged, Hungary.
| | - Edit Urbán
- Department of Medical Microbiology and Immunology, Clinical Center, University of Pécs, Szigeti út 12., 7624, Pécs, Hungary.
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