Assessment of Changes in the Oral Microbiome That Occur in Dogs with Periodontal Disease

Microbial Composition of Extracted Dental Alveoli in Dogs with Advanced Periodontitis

Periodontitis is a serious gum infection that damages the soft tissue and destroys the bone supporting the teeth. The aim of the study was to investigate the microbiota using traditional microbiology plating and metagenomic sequencing of extracted tooth alveoli in dogs with severe periodontitis. Isolation of culturable microorganisms was performed as part of bacteriological testing to provide bacteriological diagnosis to veterinary surgeons. Metagenomic sequencing was performed using shotgun sequencing on the Illumina HiSeq system platform. The most prevalent species at sites of periodontal infection detected by metagenomic sequencing were Porphyromonas gulae, Prevotella spp., Tannerella forsythia, Porphyromonas crevioricanis, Porphyromonas cangingivalis, and Bacteroides heparinolyticus. Pasteurella, Streptococcus, and Neisseria were the most frequently isolated culturable bacteria from infected sites detected by traditional microbiologic methods. Metagenomic data revealed that these three genera accounted for only 1.6% of all microbiota at the sites of infection. Antimicrobial resistance patterns of the isolated bacteria included resistance to ampicillin, doxycycline, sulfamethoxazole-trimethoprim, ciprofloxacin, colistin, cefotaxime, and chloramphenicol. Antimicrobial-resistant genes detected using shotgun sequencing also showed resistance to aminoglycosides and macrolides. Dogs with periodontal infections carry bacteria that can cause bite infections in humans as well as multi-resistant isolates. Therefore, treatment and prophylaxis or periodontal disease of dogs is important from a One Health perspective.

Age-correlated changes in the canine oral microbiome

Introduction

Canine oral disease has been associated with significant changes in the oral microbiome rather than the presence or absence of individual species. In addition, most studies focus on a single age group of canines and as of yet, the relationship between canine microbiomes and age is poorly understood.

Methods

This study used a shotgun whole gene sequencing approach in tandem with the Aladdin Bioinformatics platform to profile the microbiomes of 96 companion dogs, with the sourmash-zymo reference database being used to perform taxonomic profiling.

Results

Findings showed significant age correlations among 19 species, including positive correlations among several Porphyromonas species and a negative correlation with C. steedae. Although a significant correlation was found between predicted and actual ages, ElasticNet Regression was unable to successfully predict the ages of younger canines based on their microbiome composition. Both microbiome samples and microbial species were successfully clustered by age group or age correlation, showing that the age-microbiome relationship survives dimensionality reduction. Three distinct clusters of microbial species were found, which were characterized by Porphyromonas, Conchiformibius, and Prevotella genera, respectively.

Discussion

Findings showed that the microbiomes of older dogs resembled those that previous literature attributed to dogs with periodontal disease. This suggests that the process of aging may introduce greater risks for canine oral disease.

Species-level characterization of saliva and dental plaque microbiota reveals putative bacterial and functional biomarkers of periodontal diseases in dogs

Periodontal diseases are among the most common bacterial-related pathologies affecting the oral cavity of dogs. Nevertheless, the canine oral ecosystem and its correlations with oral disease development are still far from being fully characterized. In this study, the species-level taxonomic composition of saliva and dental plaque microbiota of 30 healthy dogs was investigated through a shallow shotgun metagenomics approach. The obtained data allowed not only to define the most abundant and prevalent bacterial species of the oral microbiota in healthy dogs, including members of the genera Corynebacterium and Porphyromonas, but also to identify the presence of distinct compositional motifs in the two oral microniches as well as taxonomical differences between dental plaques collected from anterior and posterior teeth. Subsequently, the salivary and dental plaque microbiota of 18 dogs affected by chronic gingival inflammation and 18 dogs with periodontitis were compared to those obtained from the healthy dogs. This analysis allowed the identification of bacterial and metabolic biomarkers correlated with a specific clinical status, including members of the genera Porphyromonas and Fusobacterium as microbial biomarkers of a healthy and diseased oral status, respectively, and genes predicted to encode for metabolites with anti-inflammatory properties as metabolic biomarkers of a healthy status.

Characterization of oral microbiota in 6-8-month-old small breed dogs

BACKGROUND

Periodontitis is the most common oral disease in dogs, and its progression and severity are influenced by risk factors, such as age and body size. Recent studies have assessed the canine oral microbiota in relation to different stages of periodontitis and niches within the oral cavity. However, knowledge of the bacterial composition at different ages and body sizes, especially in puppies, is limited. This study aimed to characterize the oral microbiota in the healthy gingiva of small breed puppies using next-generation sequencing. Additionally, we assessed the impact of dental care practices and the presence of retained deciduous teeth on the oral microbiota.

RESULTS

In this study, plaque samples were collected from the gingival margin of 20 small breed puppies (age, 6.9 ± 0.6 months). The plaque samples were subjected to next-generation sequencing targeting the V3-V4 region of the 16 S rRNA. The microbiota of the plaque samples was composed mostly of gram-negative bacteria, primarily Proteobacteria (54.12%), Bacteroidetes (28.79%), and Fusobacteria (5.11%). Moraxella sp. COT-017, Capnocytophaga cynodegmi COT-254, and Bergeyella zoohelcum COT-186 were abundant in the oral cavity of the puppies. In contrast, Neisseria animaloris were not detected. The high abundance of Pasteurellaceae suggests that this genus is characteristic of the oral microbiota in puppies. Dental care practices and the presence of retained deciduous teeth showed no effects on the oral microbiota.

CONCLUSIONS

In this study, many bacterial species previously reported to be detected in the normal oral cavity of adult dogs were also detected in 6-8-month-old small breed dogs. On the other hand, some bacterial species were not detected at all, while others were detected in high abundance. These data indicate that the oral microbiota of 6-8-month-old small breed dogs is in the process of maturating in to the adult microbiota and may also have characteristics of the small dog oral microbiota.

Use of Ozone in Veterinary Dentistry as an Alternative to Conventional Antibiotics and Antiseptics

This paper aims to assess the disinfecting capacity of a double-distilled ozonated water solution as an alternative to common antibiotic and antiseptic devices. Seventy-five dogs were subjected to the surgical procedures of scaling and dental extraction and included in three study groups: Group 1 subjected to antibiotic pre-treatment (association amoxicillin + clavulanic acid and ampicillin + metronidazole) and disinfection with chlorhexidine, and Group 2 and 3 devoid of preventive anti-microbial treatment in which disinfection was performed, respectively, with ozonated water and chlorhexidine. Sampling by bacteriological buffer was carried out to evaluate the bacterial count in the oral cavity. The analysis of the samples determined the total mesophilic bacterial count by seeding on the culture medium via the inclusion of PCA (Plate Count Agar). The results highlighted the anti-bacterial efficacy of intra-operative ozone as an alternative to pre-surgical antibiotic treatment.

From wolves to humans: oral microbiome resistance to transfer across mammalian hosts

The mammalian mouth is colonized by complex microbial communities, adapted to specific niches, and in homeostasis with the host. Individual microbes interact metabolically and rely primarily on nutrients provided by the host, with which they have potentially co-evolved along the mammalian lineages. The oral environment is similar across mammals, but the diversity, specificity, and evolution of community structure in related or interacting mammals are little understood. Here, we compared the oral microbiomes of dogs with those of wild wolves and humans. In dogs, we found an increased microbial diversity relative to wolves, possibly related to the transition to omnivorous nutrition following domestication. This includes a larger diversity of Patescibacteria than previously reported in any other oral microbiota. The oral microbes are most distinct at bacterial species or strain levels, with few if any shared between humans and canids, while the close evolutionary relationship between wolves and dogs is reflected by numerous shared taxa. More taxa are shared at higher taxonomic levels including with humans, supporting their more ancestral common mammalian colonization followed by diversification. Phylogenies of selected oral bacterial lineages do not support stable human-dog microbial transfers but suggest diversification along mammalian lineages (apes and canids). Therefore, despite millennia of cohabitation and close interaction, the host and its native community controls and limits the assimilation of new microbes, even if closely related. Higher resolution metagenomic and microbial physiological studies, covering a larger mammalian diversity, should help understand how oral communities assemble, adapt, and interact with their hosts.IMPORTANCENumerous types of microbes colonize the mouth after birth and play important roles in maintaining oral health. When the microbiota-host homeostasis is perturbed, proliferation of some bacteria leads to diseases such as caries and periodontitis. Unlike the gut microbiome, the diversity of oral microbes across the mammalian evolutionary space is not understood. Our study compared the oral microbiomes of wild wolves, dogs, and apes (humans, chimpanzees, and bonobos), with the aim of identifying if microbes have been potentially exchanged between humans and dogs as a result of domestication and cohabitation. We found little if any evidence for such exchanges. The significance of our research is in finding that the oral microbiota and/or the host limit the acquisition of exogenous microbes, which is important in the context of natural exclusion of potential novel pathogens. We provide a framework for expanded higher-resolution studies across domestic and wild animals to understand resistance/resilience.

The Oral Microbiome across Oral Sites in Cats with Chronic Gingivostomatitis, Periodontal Disease, and Tooth Resorption Compared with Healthy Cats

Feline chronic gingivostomatitis (FCGS) is a chronic mucosal and gingival inflammatory disease in which pathogenesis remains unclear. Interactions between the host inflammatory process, the host immune response, and the oral microbiome are implicated in this pathogenesis. To begin to understand this disease and the impact of the microbiome to host inflammatory disease states, we collected sterile noninvasive plaque biofilm samples from ten distinct sites within the oral cavity in cats with stomatitis (n = 12), healthy cats (n = 9), and cats with tooth resorption or periodontitis (n = 11). Analysis of full-length 16S rRNA gene sequences indicated that the microbiomes of cats with FCGS presented marked dysbiosis at multiple oral sites. Additionally, microbiome beta diversity varied with oral condition, indicating that stomatitis, periodontitis, and/or tooth resorption influence the microbiome differently. Lastly, we found that the microbiomes of swabs taken from the oral cavity were comparable to those taken from plaque using endodontic paper points, validating this as another sampling method. Collectively, our work furthers our understanding of the dysbiosis and composition of bacteria in the oral microbiome in FCGS, with hopes of contributing to the prevention, diagnosis, and treatment of this challenging condition in felines.

Comparison of Oral Microbial Composition and Determinants Encoding Antimicrobial Resistance in Dogs and Their Owners

Consolidated studies on animal, human, and environmental health have become very important for understanding emerging zoonotic diseases and the spread of antimicrobial resistance (AMR). The aim of this study was to analyse the oral microbiomes of healthy dogs and their owners, including determinants of AMR. Shotgun metagenomic sequencing detected 299 bacterial species in pets and their owners, from which 70 species were carried by dogs and 229 species by humans. Results demonstrated a unique microbial composition of dogs and their owners. At an order level, Bacteroidales were the most prevalent oral microbiota of dogs with significantly lower prevalence in their owners where Actinomycetales and Lactobacillales predominated. Porphyromonas and Corynebacterium were the most prevalent genera in dogs, whereas Streptococcus and Actinomyces were in animal owners. The resistances to macrolides, tetracyclines, lincosamides and Cfx family A class broad-spectrum β-lactamase were detected in both animal and human microbiomes. Resistance determinants to amphenicols, aminoglycosides, sulphonamides, and quaternary ammonium compounds were detected exceptionally in dogs. In conclusion, the study demonstrated different bacterial composition in oral microbiomes of healthy dogs without clinical signs of periodontal disease and their owners. Due to the low numbers of the samples tested, further investigations with an increased number of samples should be performed.

Effectiveness of silver diamine fluoride 38% on reduction of gingivitis in dogs: a randomized clinical trial

Introduction

Periodontal disease is a ubiquitous disease in small animal veterinary medicine. Currently regular professional dental cleaning and daily tooth brushing are considered gold standards in the prevention of periodontal disease. Efforts to find a noninvasive, cost effective and easy to use preventative for periodontal disease are ongoing. The primary objective of this double-blind randomized clinical trial was to determine if a single application of silver diamine fluoride (SDF) 38% on the buccal surface of all teeth would reduce gingivitis within 3 months in dogs with stage two periodontal disease.

Methods

Twenty-nine client-owned dogs 3-12 years old, 6-35 pounds were randomized 1:1 into active and placebo-control groups. Both groups underwent a baseline treatment and a three-month follow-up under general anesthesia. Gingival Index (GI), Plaque Index (PI), and Calculus Index (CI) were assessed and recorded at each event.

Results

A single application of SDF 38% did not significantly lower GI relative to the control group. However, the GI score dropped significantly in both groups relative to baseline, with a 53% reduction in the average GI score for dogs that received SDF 38% treatment and a 44% reduction for dogs that received placebo treatment. There were no differences in PI or CI scores compared to control groups.

Conclusion

Further research is needed to determine if a more frequent application or a longer study duration would yield a different outcome.

Developing diagnostic tools for canine periodontitis: combining molecular techniques and machine learning models

BACKGROUND

Dental plaque microbes play a key role in the development of periodontal disease. Numerous high-throughput sequencing studies have generated understanding of the bacterial species associated with both canine periodontal health and disease. Opportunities therefore exist to utilise these bacterial biomarkers to improve disease diagnosis in conscious-based veterinary oral health checks. Here, we demonstrate that molecular techniques, specifically quantitative polymerase chain reaction (qPCR) can be utilised for the detection of microbial biomarkers associated with canine periodontal health and disease.

RESULTS

Over 40 qPCR assays targeting single microbial species associated with canine periodontal health, gingivitis and early periodontitis were developed and validated. These were used to quantify levels of the respective taxa in canine subgingival plaque samples collected across periodontal health (PD0), gingivitis (PD1) and early periodontitis (PD2). When qPCR outputs were compared to the corresponding high-throughput sequencing data there were strong correlations, including a periodontal health associated taxa, Capnocytophaga sp. COT-339 (rs =0.805), and two periodontal disease associated taxa, Peptostreptococcaceae XI [G-4] sp. COT-019 (rs=0.902) and Clostridiales sp. COT-028 (rs=0.802). The best performing models, from five machine learning approaches applied to the qPCR data for these taxa, estimated 85.7% sensitivity and 27.5% specificity for Capnocytophaga sp. COT-339, 74.3% sensitivity and 67.5% specificity for Peptostreptococcaceae XI [G-4] sp. COT-019, and 60.0% sensitivity and 80.0% specificity for Clostridiales sp. COT-028.

CONCLUSIONS

A qPCR-based approach is an accurate, sensitive, and cost-effective method for detection of microbial biomarkers associated with periodontal health and disease. Taken together, the correlation between qPCR and high-throughput sequencing outputs, and early accuracy insights, indicate the strategy offers a prospective route to the development of diagnostic tools for canine periodontal disease.

Bacterial community associated with gingivitis and periodontitis in dogs

Periodontal disease is a chronic condition characterized by bacterial adhesion, followed by biofilm formation, and subsequently by an inflammatory process that progresses to gingivitis and later to periodontitis. The variations in the oral microbiota have been associated with the progression of this disease. This study evaluated the alteration of the cultivable oral microbiota in dogs with different oral health status. Thirty dogs were selected and divided into three groups: healthy, gingivitis, and periodontitis. The collected oral samples were seeded, and colonies with distinct phenotypic characteristics were isolated and classified using sequencing of the 16S rRNA gene. The DNA sequences were aligned, and a phylogenetic tree was constructed. Simpson's diversity index was calculated, and a dissimilarity matrix based on the Jaccard similarity index was used to plot a principal coordinate analysis. A total of 119 bacteria with different colony morphologies were isolated and classified into 4 phyla, 29 genera, and 45 species based on phylogenetic analysis. The results indicated an increase in bacteria belonging to the Proteobacteria phylum and a less extended decrease in Actinobacteria, Firmicutes, and Bacteroidetes phyla in dogs with periodontal disease (gingivitis and periodontitis) compared to healthy dogs. Representatives of the genera Neisseria sp., Corynebacterium sp., Pasteurella sp., and Moraxella sp. increased through the worsening of the periodontal disease, while Staphylococcus sp. decreased. All groups exhibited moderate to high levels of biodiversity index, and the plotted PCoA show a clear separation in the oral microbiome of dogs with periodontitis compared to dogs with gingivitis and the healthy group.

Influence of Gallic Acid-Containing Mouth Spray on Dental Health and Oral Microbiota of Healthy Dogs: A Pilot Study

The pilot study aimed to investigate the effects of GAMS on oral microbiota in healthy dog subjects. Thirty-eight dogs were recruited and randomly allocated to the placebo (n = 19) and treatment groups (n = 19). The dogs were treated with mouth spray once daily for 42 days. The changes in the gingival index (GI), plaque index (PI), and calculus index (CI) were measured at baseline (day 0) and end of the study (42nd day). The changes in the oral microbial composition of representative dogs (placebo, n = 7; and treatment, n = 7) were also evaluated at baseline and end of the study. Oral microbial composition was assessed by sequencing. The sequences were annotated using the QIIME 2.0^TM. The GI, PI, and CI indexes were reduced after the GAMS usage. The abundance of the commensal bacterial phylum Actinobacteria and Chloroflexi, genera Frederiksenia, and Bergeyella was improved after six weeks of GAMS usage. GAMS reduced the pathogenic bacterial species, including Neisseria sp., Desulfobulbus sp., Capnocytophaga canis, and Corynebacterium mustelae. Moreover, some pathogenic bacterial abundances were increased at the end of the study. All the microbial variations were observed within the group. The inter-group analysis revealed that the changes were unrelated to GAMS usage. Further studies need to be carried out using more experimental subjects to confirm the effectiveness of GAMS. More metagenomic data are required to evidence the GMAS impact on the oral microbiome of healthy dogs.

Natural Antimicrobials Promote the Anti-Oxidative Inhibition of COX-2 Mediated Inflammatory Response in Primary Oral Cells Infected with Staphylococcus aureus, Streptococcus pyogenes and Enterococcus faecalis

Staphylococcus aureus, Streptococcus pyogenes and Enterococcus faecalis can colonize the tooth root canals, adhere to dentin walls, and frequently cause periodontitis in dogs. Bacterial periodontal diseases are common in domesticated pets, causing severe oral cavity inflammation and a strong immune response. This study investigates the antioxidant effect of a natural antimicrobial mixture (Auraguard-Ag) on the ability of S. aureus, S. pyogenes and E. faecalis to infect primary canine oral epithelial cells as well as its impact on their virulence factors. Our data show that a concentration of 0.25% Ag is sufficient to inhibit the growth of all three pathogens, whereas a concentration of 0.5% will become bactericidal. The sub-inhibitory concentration of 0.125% Ag reveals that the antimicrobial mixture can significantly reduce biofilm formation and exopolysaccharide production. The impact on these virulence factors was further translated into a significantly reduced ability to infect primary canine oral epithelial cells and restore epithelial tight junctions, with no impact on the epithelial cell viability. The post-infection inflammatory cytokines (IL-1β and IL-8) and the COX-2 mediator were also reduced both in mRNA and protein expression levels. The oxidative burst, detected upon infection, was also decreased in the presence of Ag, as our results show a significant decrease in H₂O₂ released by the infected cells. We show that inhibition of either NADPH or ERK activity will result in a downregulation of COX-2 expression and lower levels of H₂O₂ in infected cells. Conclusively, our study shows that natural antimicrobials reduce pro-inflammatory events, post infection, through an antioxidative mechanism that involves the downregulation of the COX-2 mediator via the inactivation of ERK in the absence of H₂O₂. As a result, they significantly reduce the risk of secondary bacterial infections and host oxidative stress caused by Staphylococcus aureus, Streptococcus pyogenes and Enterococcus faecalis accumulation in biofilms in an in vitro canine oral infection model.

Molecular microbiological characteristics of gingival pockets in the periodontal diseases of dogs

Introduction

Canine periodontitis results among other factors from a disturbed balance of dental plaque microflora and an inadequate host inflammatory response to a stimulus. This investigation sought to identify microorganisms associated with canine periodontitis.

Material and Methods

Microbiological analysis was undertaken of gingival pockets in an experimental group of 36 dogs with periodontal diseases. Swabs were collected with the use of Pet Test (MIP Pharma, Berlin, Germany) from patients with gingival pockets deeper than 5 mm. Samples were aggregated and placed in separate shipping containers with the Pet Test kit.

Results

Identification was made of the most common microorganisms, e.g. Porphyromonas gingivalis, Treponema denticola and Prevotella intermedia. The red complex constituted the largest proportion of all analysed organisms (84.26%). Capnocytophaga gingivalis was isolated from 33 dogs, Peptostreptococcus micros from 32 dogs, Fusobacterium nucleatum from 29 animals and P. intermedia from 20.

Conclusion

The highest percentage of pathogens was supplied by P. gingivalis (61%). It is thought that dogs acquire them by means of cross-species transmission. The inter-study variability of results may depend not only on the method of periopathogen detection, but also on environmental factors, host immune status or genetic background. Depending on the state of periodontal disease, patients show varied microbiological profiles of the gingival pockets.

The association between gingivitis and oral spirochetes in young cats and dogs

Although gingivitis frequently occurs in young cats, spirochetes are often found in the early stages of periodontal disease. This study was conducted to determine the association between gingivitis and oral spirochetes in young cats and dogs. The degree of gingivitis was evaluated in a total of 68 cats and 31 dogs under one year of age, and plaques were collected from each carnassial. To detect spirochetes or Porphyromonas gulae in plaque samples, 16S rRNA gene was amplified by polymerase chain reaction (PCR) using specific primers. All data were analyzed using Fisher's exact probability test and odds ratio (OR) with a 95% confidence interval (95% CI). The prevalence of gingivitis was significantly higher in young cats (92.6%) than in young dogs (45.2%). The positive rate of spirochetes by PCR in gingivitis cases was 85.4% in young cats and 15.4% in young dogs, and the positive rate of P. gulae was 66.7% in young cats and 15.4% in young dogs. Both results were significantly higher in young cats than in young dogs. In young cats, spirochetes were significantly associated with gingivitis (OR = 7.95; 95% CI = 1.17, 53.83; P < 0.05), but P. gulae was not (OR = 2.44; 95% CI = 0.38, 15.66; P = 0.23). These results suggest that spirochetes may be associated with the early stages of periodontal disease in cats.

Prevalence of Periodontal Pathogens in Slovak Patients with Periodontitis and Their Possible Aspect of Transmission from Companion Animals to Humans

Oral health and diseases are greatly influenced by oral bacteria. During dysbiosis, bacterial composition changes, which can lead to periodontitis. Periodontitis in humans is associated with periodontal pathogens such as Treponema denticola, Porphyromonas gingivalis, Tannerella forsythia and Aggregatibacter actinomycetemcomitans. Animal-to-human transmission of some of these pathogens has also been reported. The aim of this study was to evaluate the prevalence of periodontal pathogens in Slovak patients and to assess the possible risk of transmission of these pathogens from animals to their owners. The presence of periodontal pathogens in dental plaque was monitored by PCR. Amplified products were analysed using Sanger sequencing. T. forsythia isolates were assessed for the susceptibility to different antibiotics using the disk diffusion method. In humans, T. denticola, P. gingivalis, T. forsythia and A. actinomycetemcomitans were present in 69.23%, 69.23%, 100% and 84.62%, respectively. Most isolates of T. forsythia were susceptible to amoxicillin-clavulanic acid, clindamycin and moxifloxacin, but they were resistant to metronidazole. The transmission of T. forsythia from animals to their owners was not proven based on sequence analysing. On the other hand, transmission of Porphyromonas gulae was confirmed, but the risk of its involvement in the pathogenesis of periodontitis in humans must be further investigated.

Effect of spiramycin and metronidazole on canine dental biofilm bacteria

Periodontal diseases are the most common condition in companion animal practice. The administration of antibiotics is associated with the therapy of these diseases. The aim of the present study was to verify the effect of antibiotics on canine dental biofilm bacteria due to increasing antibiotic resistance. Dental biofilm samples were taken from six dogs before and after administration of antibiotics, specifically, the combination of spiramycin and metronidazole. The samples were cultured on solid media under aerobic and anaerobic conditions. Sequencing analysis of the 16S rRNA gene was used to identify bacterial isolates. In addition, total bacterial DNA was extracted from samples from one dog and the V3−V4 region of the 16S rRNA gene was sequenced using the Illumina MiSeq platform. Using cultivation, 55 isolates belonging to 4 phyla were isolated before antibiotics administration, and 36 isolates belonging to 3 phyla were isolated after antibiotics administration. A significant decrease was noted in the genera Porphyromonas, Neisseria and Frederiksenia, whereas there was a significant increase in the genus Streptococcus. Of the total microbiota, there were 69 operational taxonomic units (OTUs) belonging to 11 phyla before antibiotics administration, and 51 OTUs belonging to 8 phyla after antibiotics administration. A significant decrease was recorded in the genus Porphyromonas, while a significant increase in the genus Capnocytophaga. The significant effect of spiramycin and metronidazole on the genus Porphyromonas at the time of their administration was confirmed by both cultivation and amplicon sequencing.