1
|
Meisgeier A, Pienkohs S, Dürrschnabel F, Neff A, Halling F. Rising incidence of severe maxillofacial space infections in Germany. Clin Oral Investig 2024; 28:264. [PMID: 38644434 PMCID: PMC11033243 DOI: 10.1007/s00784-024-05663-w] [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: 01/23/2024] [Accepted: 04/16/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVES Severe maxillofacial space infection (MSI) as an end stage of dentoalveolar diseases or complication of sialadenitis is a potentially life-threatening disease accompanied by complications including airway obstruction, jugular vein thrombosis, descending mediastinitis, sepsis and acute respiratory distress syndrome. The aim of this study was to analyze the incidence and time trends of severe MSI and potentially influencing factors in the German healthcare system over time. MATERIALS AND METHODS Nationwide data regarding the national diagnosis-related-group (DRG) inpatient billing system was received from the German Federal Statistical Office. A retrospective analysis of incidence and time trends of MSI-associated procedures classified with the Operation and Procedure Classification System (OPS), were statistically evaluated using Poisson regression analysis between 2005 and 2022 and were associated with different epidemiological factors. RESULTS The total standardized incidence rate of MSI-associated procedures in the observational period 2005-2022 was 9.8 (♀8.2; ♂11.4) per 100,000 person years. For all age groups a significant increase of 46.1% in severe MSI - related surgical interventions was registered within the observational period. The largest increase (120.5%) was found in elderly patients over 80 years. There were significant differences of the incidences of MSI-associated surgeries between the different federal states in Germany. CONCLUSIONS Severe MSI are a growing challenge in German health care especially among elderly patients over 80 years. CLINICAL RELEVANCE Severe MSI is a promising target for prevention. There should be more focus in primary dental and medical care especially in groups depending on social support.
Collapse
Affiliation(s)
- Axel Meisgeier
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg and Faculty of Medicine, Philipps University, 35043, Marburg, Germany.
| | - Simon Pienkohs
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg and Faculty of Medicine, Philipps University, 35043, Marburg, Germany
| | - Florian Dürrschnabel
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg and Faculty of Medicine, Philipps University, 35043, Marburg, Germany
| | - Andreas Neff
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg and Faculty of Medicine, Philipps University, 35043, Marburg, Germany
| | - Frank Halling
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg and Faculty of Medicine, Philipps University, 35043, Marburg, Germany
- Gesundheitszentrum Fulda, Praxis für MKG-Chirurgie, Gerloser Weg 23a, D-36039, Fulda, Germany
| |
Collapse
|
2
|
van der Merwe P, Rule R, Olorunju S, Jacobs F. The empirical use of aminoglycosides in Ludwig's angina based on bacterial analysis of 63 cases. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101409. [PMID: 36738888 DOI: 10.1016/j.jormas.2023.101409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 01/29/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023]
Abstract
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.
Collapse
Affiliation(s)
- Petrie van der Merwe
- Department of Maxillofacial and Oral Surgery, Faculty of Health Sciences, School of Dentistry, Oral and Dental Hospital, University of Pretoria, C/o Steve Biko and Dr Savage Roads, Gezina, Pretoria 0002, South Africa.
| | - Roxanne Rule
- Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; Department of Medical Microbiology, National Health Laboratory Services, Tshwane Academic Division, Pretoria, South Africa
| | - Steve Olorunju
- Biostatistics Unit (Pretoria office), South African Medical Research Council (SAMRC), South Africa
| | - Fred Jacobs
- Department of Maxillofacial and Oral Surgery, Faculty of Health Sciences, School of Dentistry, Oral and Dental Hospital, University of Pretoria, C/o Steve Biko and Dr Savage Roads, Gezina, Pretoria 0002, South Africa
| |
Collapse
|
3
|
Bigus S, Russmüller G, Starzengruber P, Reitter H, Sacher CL. Antibiotic resistance of the bacterial spectrum of deep space head and neck infections in oral and maxillofacial surgery - a retrospective study. Clin Oral Investig 2023; 27:4687-4693. [PMID: 37294354 DOI: 10.1007/s00784-023-05095-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 05/23/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the current resistance situation concerning routinely used antibiotics for treatment in odontogenic abscesses. MATERIALS AND METHODS This retrospective study assessed patients with deep space head and neck infections who were treated by surgical intervention under general anesthesia at our department. The target parameter was the ascertainment of the resistance rates in order to identify the bacterial spectrum, sites in the body, length of inpatient stay, and the age and sex of the patients. RESULTS A total of 539 patients, 268 (49.7%) males and 271 (50.3%) females were included in the study. The mean age was 36.5 ± 22.1 years. There was no significant difference between the two sexes with regard to the mean duration of hospitalization (p = 0.574). The predominant bacteria in the aerobic spectrum were streptococci of the viridans group and staphylococci, in the anaerobic spectrum Prevotella and Propionibacteria spp. Rates of resistance to clindamycin were between 34 and 47% in both the facultative and obligate anaerobic spectrum. Increased resistance was likewise found in the facultative anaerobic spectrum, with 94% resistance to ampicillin and 45% to erythromycin. CONCLUSION Due to the increasing levels of resistance to clindamycin, their use in empiric antibiotic treatment for deep space head and neck infections should be viewed critically. CLINICAL RELEVANCE Resistance rates continue to increase compared to previous studies. The use of these antibiotic groups in patients with a penicillin allergy needs to be called into question and alternative medications sought.
Collapse
Affiliation(s)
- Simon Bigus
- Department of Oral and Maxillofacial Surgery, Campus Virchow-Klinikum, Charité - University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Günter Russmüller
- Department of Oral and Maxillofacial Surgery, University Hospital Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Peter Starzengruber
- Department of Laboratory Medicine, University Hospital Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Hannah Reitter
- Austrian Public Health Insurance, Wienerbergstrasse 13, 1100, Vienna, Austria
| | | |
Collapse
|
4
|
Mochalov I, Kryvtsova M, Chobey A, Kulynych M. Identification of Pathogenic Microflora and Its Sensitivity to Antibiotics in Cases of the Odontogenic Purulent Periostitis and Abscesses in the Oral Cavity. Prague Med Rep 2023; 124:16-32. [PMID: 36763828 DOI: 10.14712/23362936.2023.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
Odontogenic infections are the most common infectious and inflammatory diseases of the maxillofacial area and problem of the causative pathogen identification is an actual task, part of a permanent process of updating and modernization of treatment and diagnostic protocols and standards. In presented study a purulent exudate from 13 patients with acute purulent odontogenic intraoral lesions was studied by bacteriological method with detection of sensitivity to antibacterial agents. Bacteriological studies showed that genus Streptococcus predominated in 69.23% cases. Pathogenic microorganisms in clinically significant concentrations (105 per 1 ml and above) (Streptococcus and Staphylococcus) were resistant to Tetracycline and Doxycycline, had moderate sensitivity to macrolides in 22.22% and resistance in 77.78%. Amoxicillin/clavulanate caused effective growth retardation in 22.22% cases and moderate delay - in 77.78% without cases of resistance. Sensitivity to cephalosporins was detected in 50.00% cases, moderate sensitivity - in 38.89%, resistance - in 11.11%. Fluoroquinolones were the most effective - sensitivity in 72.22% cases, moderate sensitivity - in 22.22%, resistance - in 5.56%. The most effective fluoroquinolones were Moxifloxacin and Ciprofloxacin. The highest resistance to antifungal agents was shown by genus Candida, antifungal susceptibility was observed only in 20.00% cases. The microbiota of purulent odontogenic inflammation in the oral cavity was identified in clinically significant concentrations in only 61.54% cases with predominance of Streptococcus. The most effective antibacterial agents for odontogenic purulent process may be considered among cephalosporins and fluoroquinolones. There is a need to repeat similar studies in other regions of Ukraine and at other times of the year.
Collapse
Affiliation(s)
- Iurii Mochalov
- Department of Surgical Dentistry and Clinical Subjects, Uzhhorod National University, Uzhhorod, Ukraine.
| | - Maryna Kryvtsova
- Department of Genetics, Plant Physiology and Microbiology, Uzhhorod National University, Uzhhorod, Ukraine
| | - Andrij Chobey
- Department of Prosthetic Dentistry, Uzhhorod National University, Uzhhorod, Ukraine
| | - Mariya Kulynych
- Department of Surgical Dentistry and Clinical Subjects, Uzhhorod National University, Uzhhorod, Ukraine
| |
Collapse
|
5
|
Retrospective Longitudinal Study on Changes in Atmospheric Pressure as a Predisposing Factor for Odontogenic Abscess Formation. Dent J (Basel) 2023; 11:dj11020042. [PMID: 36826187 PMCID: PMC9955754 DOI: 10.3390/dj11020042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
In our retrospective longitudinal study based on the data from 292 patients, we wanted to investigate whether there was an association between weather conditions and the occurrence of odontogenic abscesses (OA) requiring hospitalization. In the adult group (249 patients), the incidence of severe OA was highest in winter (32.9%) during January (11.6%), with the most common localizations being the perimandibular (35.7%) and submandibular (23.3%) regions. We found that changes in mean daily atmospheric pressure five days before hospitalization showed a positive association with the occurrence of OA, especially pressure variations greater than 12 hPa. Atmospheric pressure changes two and five days before hospitalization were also found to be moderate predictors of complications during treatment. Antibiogram analysis revealed resistance of streptococci to clindamycin in 26.3%. In the pediatric group, OA were also most frequent in winter (30.2%), and the perimandibular region (37.2%) and the canine fossa (20.9%) were the most frequent abscess localizations, while an association with meteorological parameters was not demonstrated. Clinical experience teaches us that weather change influences the occurrence of severe OA requiring hospitalization, which we confirmed in this research. To our knowledge, our study is the first to provide a threshold and precise time frame for atmospheric pressure changes.
Collapse
|
6
|
Microbiology of Facial Skin Infections-Strains, Susceptibility, and Therapeutic Consequences. J Oral Maxillofac Surg 2023; 81:641-647. [PMID: 36682386 DOI: 10.1016/j.joms.2022.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 12/30/2022] [Accepted: 12/30/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Skin and soft tissue infections (SSTIs) are common conditions with severe and potentially life-threatening outcomes. However, the use of antibiotics to treat these infections is controversial. PURPOSE This study was to identify the microorganisms responsible for facial SSTIs, their antibiotic sensitivities, and the therapeutic outcomes of treatment. STUDY DESIGN, SETTING, AND SAMPLE This was a retrospective, observational cohort study conducted at a single oral and maxillofacial plastic surgery department. The study sample included 103 patients with facial SSTIs (61 men, 42 women) with a mean age of 41.8 years (standard deviation ± 20.4). PREDICTOR/EXPOSURE/INDEPENDENT VARIABLES The predictor variables included patient characteristics, antibiotic use before the clinic visit, and the infection's site and origin. MAIN OUTCOME VARIABLE(S) The primary outcome variable was the presence of antibiotic resistance in the bacterial strains isolated from the infections. METHODS The data were collected by reviewing the results of microbiological swabs and patient records obtained from patients with facial SSTIs. Categorical variables were described using absolute and relative frequencies, and continuous variables were described using mean and standard deviation. The association between antibiotic resistance and the predictor variables was analyzed using Pearson's χ2 test and student's t test. RESULTS The most common cause of SSTI was an infected epidermal cyst (60.1%). Of all the microorganisms identified, 80.6% were Gram-positive, and 55.8% showed antibiotic resistance against one or more of the evaluated antibiotics, including several backup antibiotics. There were no identified risk factors that significantly influenced the probability of resistance, and there were no adverse events observed. CONCLUSION The results of this study suggest that surgery should be the primary approach for treating SSTIs, as antibiotic administration may not be effective due to the unknown susceptibility of the causative strains. Antibiotics should be reserved for severe cases and high-risk patients, and if deemed necessary for SSTI management, a broad-spectrum antibiotic should be administered to cover resistant organisms.
Collapse
|
7
|
Wang P, Huang Y, Long J. A Five-Year Retrospective Study of 746 Cases with Maxillofacial Space Infection in Western China. Infect Drug Resist 2022; 15:5099-5110. [PMID: 36068836 PMCID: PMC9441175 DOI: 10.2147/idr.s377657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose To grasp the current epidemiological situation of maxillofacial space infection and investigate the risk factors contributing to the longer hospitalization of odontogenic space infection in western China. Patients and Methods This retrospective study collected the clinical characteristics from 746 hospitalized patients with maxillofacial space infection and investigated the risk factors associated with longer hospitalization. Pearson’s chi-square test and multivariable binary logistic regression were performed for statistical analysis. Results A total of 438 males and 308 females were included in this study, aging from 1 to 90 years (mean age 48.6 years). 74.9% cases resulted from odontogenic infections, with the submandibular space being the most commonly involved space (53.7%). Advanced age (OR (>60 y:19–60 y:≤18 y) = 3.784:3.416:1, p < 0.05), treatment before admission (OR = 2.271, p < 0.05) and number of involved spaces (OR (≥4:2–3:1) = 3.204:1.931:1, p < 0.05) were closely related to longer hospitalization. Streptococcus being the most frequently found aerobic bacteria (268/615, 43.6%) of all the bacteria isolated was resistant to clarithromycin (91.5%) and erythromycin (92.8%). Conclusion Hospitalization time could be longer for patients with the identified risk factors. Streptococcus, as the most common type of aerobic flora, is highly resistant to clindamycin and erythromycin.
Collapse
Affiliation(s)
- Peihan Wang
- The State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, 610041, People’s Republic of China
- Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, 610041, People’s Republic of China
- National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Yanling Huang
- The State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, 610041, People’s Republic of China
- Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, 610041, People’s Republic of China
- National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Jie Long
- The State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, 610041, People’s Republic of China
- Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, 610041, People’s Republic of China
- National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, 610041, People’s Republic of China
- Correspondence: Jie Long, Tel +86 28 85503406, Fax +86 28 85501456, Email
| |
Collapse
|
8
|
Yousef M, Abdelazeem B, Kalantary A, Pratiti R. Late-Term Complications of COVID-19: Retropharyngeal Infection and Myocarditis in a 26-Year-Old Patient. Eur J Case Rep Intern Med 2021; 8:002759. [PMID: 34790619 DOI: 10.12890/2021_002759] [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: 07/04/2021] [Accepted: 08/13/2021] [Indexed: 11/05/2022] Open
Abstract
Deep neck space infection and viral myocarditis related to coronavirus disease 2019 (COVID-19) have both been described in the medical literature. However, there are only three reported cases of retropharyngeal infection as a presenting pathology in the setting of COVID-19. A 26-year-old woman presented to the emergency room with fever and neck swelling and pain 1 month after COVID-19 infection. A computed tomography scan of the neck demonstrated tonsillitis with retropharyngeal infection. She was also found to have heart failure with an ejection fraction (EF) of <20% due to acute myocarditis. Her infection resolved and the EF improved to 40% prior to discharge. Our case is the first to describe retropharyngeal infection as a late complication in an adult with a history of COVID-19 several weeks previously. It also presented a clinical challenge in terms of tailoring goal-directed medical therapy to manage severe left ventricular dysfunction caused by myocarditis. LEARNING POINTS Deep neck space infections may be a long-term complication of SARS-CoV-2 infection.Fever, neck swelling and pain should arouse suspicion of deep neck space infection even in adults.Acute viral myocarditis in the setting of SARS-CoV-2 can present many weeks after the initial infection.
Collapse
|
9
|
Surgical and remote site infections after reconstructive surgery of the head and neck: A risk factor analysis. J Craniomaxillofac Surg 2021; 50:178-187. [PMID: 34802884 DOI: 10.1016/j.jcms.2021.11.002] [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: 02/02/2021] [Revised: 09/27/2021] [Accepted: 11/10/2021] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to identify risk factors for surgical (SSI) and remote site (RSI) infections, pathogens and antibiotic resistances in patients after pedicled and free flap reconstruction in the head and neck area. SSI criteria implicated infections affecting superficial or deep tissue in the flap area with purulent discharge, fistula, abscess formation and local infections signs. RSI criteria were defined as infections remote from the surgical site presenting with systemic symptoms like fever, leucocytosis, increase in C-reactive protein, purulent tracheobronchial secretion or deterioration of blood gases. Focus adequate specimen sampling and aerobic and anaerobic incubation and cultivation was performed. Epidemiological data, factors directly related to surgery or reconstruction, perioperative antibiotic regimen, length of stay, autologous blood transfusion and microbiological aspects were retrospectively analysed in 157 patients. 10.8% of patients presented SSI, 12.7% RSI. Cultivated bacteria were sampled from flap sites, blood cultures, central catheters and sputum including mainly gram-negative bacteria (70.3%) being frequently resistant against penicillin (85%) and third generation cephalosporine derivates (48%). Autologous blood transfusion (p = 0.018) and perioperative clindamycin use (p = 0.002) were independent risk factors for overall (SSI and RSI combined) infections. Prior radiation (p = 0.05), autologous blood transfusion (p = 0.034) and perioperative clindamycin use (p = 0.004) were predictors for SSIs. ASA >2 (p = 0.05) was a risk factor for remote site infections and prolonged ICU stay (p = 0.002) was associated with overall infections, especially in irradiated patients. Efforts need to be made in improving patient blood management, antibiotic stewardship and accurate postoperative care to avoid postoperative infections after head and neck reconstructive surgery.
Collapse
|
10
|
Clinical Relevance of the Microbiome in Odontogenic Abscesses. BIOLOGY 2021; 10:biology10090916. [PMID: 34571794 PMCID: PMC8468448 DOI: 10.3390/biology10090916] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/30/2021] [Accepted: 09/14/2021] [Indexed: 11/17/2022]
Abstract
Simple Summary Odontogenic infections are very common. The course of disease ranges from mild to severe and sometimes even life-threatening infections. Optimal therapy is based on rapid abscess incision and, especially in severe cases, on adjuvant antibiotic therapy that ideally targets the culprit bacteria. In order to identify these bacteria, clinicians usually perform cultural analysis from smears of pus and aim for antibiotic susceptibility testing. In recent years, using new molecular methods, it has become possible to carry out a much more detailed analysis of the bacterial colonization of different parts of the human body by determining a microbiome. In our study, we have, for the first time, compared such a microbiome of odontogenic abscesses with cultural bacterial determination carried out in the clinical routine of a university hospital. The key finding of the study is not only that considerably more bacteria can be detected in the abscess in this way but also that easily cultivated bacteria dominate over the actual fastidious pathogenic bacteria. Thus, routine clinical culture probably only provides a distorted picture of reality and should be supplemented by molecular methods in the future. Abstract Odontogenic abscesses are usually caused by bacteria of the oral microbiome. However, the diagnostic culture of these bacteria is often prone to errors and sometimes fails completely due to the fastidiousness of the relevant bacterial species. The question arises whether additional pathogen diagnostics using molecular methods provide additional benefits for diagnostics and therapy. Experimental 16S rRNA gene analysis with next-generation sequencing (NGS) and bioinformatics was used to identify the microbiome of the pus in patients with severe odontogenic infections and was compared to the result of standard diagnostic culture. The pus microbiome was determined in 48 hospitalized patients with a severe odontogenic abscess in addition to standard cultural pathogen detection. Cultural detection was possible in 41 (85.42%) of 48 patients, while a pus-microbiome could be determined in all cases. The microbiomes showed polymicrobial infections in 46 (95.83%) cases, while the picture of a mono-infection occurred only twice (4.17%). In most cases, a predominantly anaerobic spectrum with an abundance of bacteria was found in the pus-microbiome, while culture detected mainly Streptococcus, Staphylococcus, and Prevotella spp. The determination of the microbiome of odontogenic abscesses clearly shows a higher number of bacteria and a significantly higher proportion of anaerobes than classical cultural methods. The 16S rRNA gene analysis detects considerably more bacteria than conventional cultural methods, even in culture-negative samples. Molecular methods should be implemented as standards in medical microbiology diagnostics, particularly for the detection of polymicrobial infections with a predominance of anaerobic bacteria.
Collapse
|
11
|
Parara E, Krasadakis C, Toursounidis I, Tsekoura K, Mourouzis C, Rallis G. Significant rise in neck infections progressing to descending necrotizing mediastinitis during the COVID-19 pandemic quarantine. J Craniomaxillofac Surg 2021; 49:1182-1186. [PMID: 34246538 PMCID: PMC8254394 DOI: 10.1016/j.jcms.2021.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/05/2021] [Accepted: 06/30/2021] [Indexed: 12/23/2022] Open
Abstract
To present five patients with DNM, who were treated during the first quarantine for Coronavirus disease 2019 (Covid-19). Five patients with DNM were treated in our department during the first lockdown. The mean age of the patients was 42,2 years and four were male. Two patients were immunocompromised. Repeated surgical drainage was performed in all patients, whereas four were also subjected to elective tracheostomy during their first operation. The mean hospitalization duration was 55,4 days and mortality was 40%. During the first lockdown for the Covid-19, a rise in the ratio of DNM cases to the overall incidence of cervicofacial infections was observed in our department. All patients with DNM were operated on an emergency basis and were subsequently admitted to the ICU. We consider the effect of the quarantine as a decisive factor for this escalation, because according to the department archives, there had not been any cases of DNM originating from a dental infection, for the past 5 years. Additionally, past studies from the same department reported no more than 6 cases over a 10 year period.
Collapse
Affiliation(s)
- Eleni Parara
- Oral and Maxillofacial Surgery Department, KAT General Hospital of Attica, 2 Nikis street, 14561, Attica, Greece.
| | - Christos Krasadakis
- Oral and Maxillofacial Surgery Department, KAT General Hospital of Attica, 2 Nikis street, 14561, Attica, Greece
| | - Iordanis Toursounidis
- Oral and Maxillofacial Surgery Department, KAT General Hospital of Attica, 2 Nikis street, 14561, Attica, Greece
| | - Konstantina Tsekoura
- Oral and Maxillofacial Surgery Department, KAT General Hospital of Attica, 2 Nikis street, 14561, Attica, Greece
| | - Constantinos Mourouzis
- Oral and Maxillofacial Surgery Department, KAT General Hospital of Attica, 2 Nikis street, 14561, Attica, Greece
| | - George Rallis
- Oral and Maxillofacial Surgery Department, KAT General Hospital of Attica, 2 Nikis street, 14561, Attica, Greece
| |
Collapse
|
12
|
Microbiome of Odontogenic Abscesses. Microorganisms 2021; 9:microorganisms9061307. [PMID: 34208451 PMCID: PMC8234849 DOI: 10.3390/microorganisms9061307] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/12/2021] [Accepted: 06/14/2021] [Indexed: 11/29/2022] Open
Abstract
Severe odontogenic abscesses are regularly caused by bacteria of the physiological oral microbiome. However, the culture of these bacteria is often prone to errors and sometimes does not result in any bacterial growth. Furthermore, various authors found completely different bacterial spectra in odontogenic abscesses. Experimental 16S rRNA gene next-generation sequencing analysis was used to identify the microbiome of the saliva and the pus in patients with a severe odontogenic infection. The microbiome of the saliva and the pus was determined for 50 patients with a severe odontogenic abscess. Perimandibular and submandibular abscesses were the most commonly observed diseases at 15 (30%) patients each. Polymicrobial infections were observed in 48 (96%) cases, while the picture of a mono-infection only occurred twice (4%). On average, 31.44 (±12.09) bacterial genera were detected in the pus and 41.32 (±9.00) in the saliva. In most cases, a predominantly anaerobic bacterial spectrum was found in the pus, while saliva showed a similar oral microbiome to healthy individuals. In the majority of cases, odontogenic infections are polymicrobial. Our results indicate that these are mainly caused by anaerobic bacterial strains and that aerobic and facultative anaerobe bacteria seem to play a more minor role than previously described by other authors. The 16S rRNA gene analysis detects significantly more bacteria than conventional methods and molecular methods should therefore become a part of routine diagnostics in medical microbiology.
Collapse
|
13
|
Meinen A, Reuss A, Willrich N, Feig M, Noll I, Eckmanns T, Al-Nawas B, Markwart R. Antimicrobial Resistance and the Spectrum of Pathogens in Dental and Oral-Maxillofacial Infections in Hospitals and Dental Practices in Germany. Front Microbiol 2021; 12:676108. [PMID: 34149666 PMCID: PMC8206268 DOI: 10.3389/fmicb.2021.676108] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Data on microbiological profiles in odontogenic infections are scarce. This study aimed to analyze the spectrum of pathogens and antimicrobial resistance in clinical isolates from dental and oral-maxillofacial clinical settings in Germany. We analyzed 20,645 clinical isolates (dental practices: n = 5,733; hospitals: n = 14,912) from patients with odontogenic infections using data (2012-2019) from the German Antimicrobial-Resistance-Surveillance (ARS) system. A total of 224 different species from 73 genera were found in clinical isolates from dental practices, and 329 different species from 97 genera were identified in isolates from hospital patients. In both hospitals and dental practices Streptococcus spp. (33 and 36%, respectively) and Staphylococcus spp. (21 and 12%, respectively) were the most frequently isolated microorganisms. In Streptococcus spp. isolates from hospitals, penicillin and aminopenicillin resistance proportions were 8.0% (95%CI 4.7-14.9%) and 6.9% (95%CI 4.7-9.9%), respectively. Substantially lower resistance proportions of penicillin and aminopenicillin were observed in dental practices [2.6% (95%CI 1.4-4.7%) and 2.1% (95%CI 1.1-4.0%), respectively]. Among Staphylococcus aureus isolates from hospital patients methicillin resistance proportions were 12.0% (95%CI 9.7-14.8%), which was higher than in isolates from dental practices (5.8% (95%CI 4.1-8.1%)]. High clindamycin and macrolide resistance proportions (>17%) were observed in Streptococcus spp. and Staphylococcus aureus isolates. In Klebsiella spp. isolates carbapenem resistance proportions were <1%. In sum, substantial antibiotic resistance was observed in isolates from odontogenic infections, which calls for strengthened efforts in antibiotic stewardship and infection prevention and control measures in both hospitals and dental practices.
Collapse
Affiliation(s)
- Annika Meinen
- Robert Koch Institute, Unit 37: Nosocomial Infections, Surveillance of Antimicrobial Resistance and Consumption, Berlin, Germany
| | - Annicka Reuss
- Robert Koch Institute, Unit 37: Nosocomial Infections, Surveillance of Antimicrobial Resistance and Consumption, Berlin, Germany
| | - Niklas Willrich
- Robert Koch Institute, Unit 37: Nosocomial Infections, Surveillance of Antimicrobial Resistance and Consumption, Berlin, Germany
| | - Marcel Feig
- Robert Koch Institute, Unit 37: Nosocomial Infections, Surveillance of Antimicrobial Resistance and Consumption, Berlin, Germany
| | - Ines Noll
- Robert Koch Institute, Unit 37: Nosocomial Infections, Surveillance of Antimicrobial Resistance and Consumption, Berlin, Germany
| | - Tim Eckmanns
- Robert Koch Institute, Unit 37: Nosocomial Infections, Surveillance of Antimicrobial Resistance and Consumption, Berlin, Germany
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Robby Markwart
- Robert Koch Institute, Unit 37: Nosocomial Infections, Surveillance of Antimicrobial Resistance and Consumption, Berlin, Germany.,Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| |
Collapse
|
14
|
Gu X, Chen W, Yuan K, Tan J, Sun S. The efficacy of artificial dermis combined with continuous vacuum sealing drainage in deep neck multiple spaces infection treatment. Medicine (Baltimore) 2021; 100:e24367. [PMID: 33592884 PMCID: PMC7870261 DOI: 10.1097/md.0000000000024367] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 12/18/2020] [Indexed: 01/05/2023] Open
Abstract
Deep neck abscesses are dangerous. Artificial dermis combined with seal negative pressure drainage is a new technique for treating refractory wounds.To compare the efficacy of vacuum sealing drainage (VSD) with that of traditional incision drainage approaches for treating deep neck multiple spaces infections.This retrospective analysis includes patient data from our hospital collected from January 2010 to March 2020. A total of 20 cases were identified. Based on the treatment methods, the patients were divided into the VSD group and the traditional group. Inflammation indicators (white blood count, WBC), duration of antibiotic use, hospitalization time, doctors' workload (frequency of dressing changes) and treatment cost were analyzed and compared between the two groups.Of the 20 patients, 11 patients underwent treatment with VSD, while the other 9 underwent traditional treatment. All patients were cured after treatment. Compared with the traditional group, the VSD group had a slower decline in the inflammation index, shorter duration of antibiotic use, shorter hospital stay, and lower doctor workloads (P < .001). There was no significant difference in treatment cost between the two groups (P > .05).VSD technology can markedly improve the therapeutic effect of deep neck multiple spaces infection. This treatment method can be used to rapidly control infections and is valuable in the clinic (P > .05).
Collapse
|
15
|
Galli M, Fusconi M, Federici FR, Candelori F, De Vincentiis M, Polimeni A, Testarelli L, Cassese B, Miccoli G, Greco A. Minimally Invasive Intraoral Approach to Submandibular Lodge. J Clin Med 2020; 9:jcm9092971. [PMID: 32937980 PMCID: PMC7563973 DOI: 10.3390/jcm9092971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/06/2020] [Accepted: 09/11/2020] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study is to describe the Minimally Invasive Intraoral Approach (MIIA) performed on selected cases of abscesses and neck phlegmons of odontogenic origin when the infection has not spread beyond the inferior mandibular margin. This technique allows us to avoid cervicotomy by a direct approach to the abscess, draining it through the oral cavity. If the limits have already been crossed, then cervicotomy is necessary. The aim of the study is to show the surgical outcomes that we have achieved during a time span of two years, and to show the effectiveness of the MIIA and its results. We selected 66 patients with abscesses and neck phlegmons, from January 2018 to June 2020. Among these cases, five patients were excluded as it was not possible to recover medical records from database. The MIIA technique has been performed on 16 patients (26.2%) when a successful dental extraction and drainage of the submandibular lodge were accomplished. The patients who underwent the MIIA surgery have all perfectly healed and did not suffer from relapses during the follow-up. The results show the achievement of excellent healing, underlining the lower impact required by MIIA when compared to a more traditional approach through cervicotomy.
Collapse
Affiliation(s)
- Massimo Galli
- Department of Oral and Maxillofacial Science, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (M.G.); (F.R.F.); (A.P.); (L.T.); (B.C.)
| | - Massimo Fusconi
- Department of Sensory Organs, Division of Otorhinolaryngology, Sapienza University of Rome, Viale del Policlinico 161, 00185 Rome, Italy; (M.F.); (F.C.); (M.D.V.); (A.G.)
| | - Francesca Romana Federici
- Department of Oral and Maxillofacial Science, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (M.G.); (F.R.F.); (A.P.); (L.T.); (B.C.)
| | - Francesca Candelori
- Department of Sensory Organs, Division of Otorhinolaryngology, Sapienza University of Rome, Viale del Policlinico 161, 00185 Rome, Italy; (M.F.); (F.C.); (M.D.V.); (A.G.)
| | - Marco De Vincentiis
- Department of Sensory Organs, Division of Otorhinolaryngology, Sapienza University of Rome, Viale del Policlinico 161, 00185 Rome, Italy; (M.F.); (F.C.); (M.D.V.); (A.G.)
| | - Antonella Polimeni
- Department of Oral and Maxillofacial Science, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (M.G.); (F.R.F.); (A.P.); (L.T.); (B.C.)
| | - Luca Testarelli
- Department of Oral and Maxillofacial Science, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (M.G.); (F.R.F.); (A.P.); (L.T.); (B.C.)
| | - Benedetta Cassese
- Department of Oral and Maxillofacial Science, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (M.G.); (F.R.F.); (A.P.); (L.T.); (B.C.)
| | - Gabriele Miccoli
- Department of Oral and Maxillofacial Science, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (M.G.); (F.R.F.); (A.P.); (L.T.); (B.C.)
- Correspondence: or ; Tel.: +39-388-045-9246
| | - Antonio Greco
- Department of Sensory Organs, Division of Otorhinolaryngology, Sapienza University of Rome, Viale del Policlinico 161, 00185 Rome, Italy; (M.F.); (F.C.); (M.D.V.); (A.G.)
| |
Collapse
|
16
|
Cefazolin versus ampicillin/sulbactam as an empiric antibiosis in severe odontogenic neck infection descending from the lower jaw-retrospective analysis of 350 cases. Clin Oral Investig 2020; 25:563-570. [PMID: 32779014 DOI: 10.1007/s00784-020-03492-1] [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: 03/20/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
Abstract
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.
Collapse
|
17
|
Heim N, Jürgensen B, Kramer FJ, Wiedemeyer V. Mapping the microbiological diversity of odontogenic abscess: are we using the right drugs? Clin Oral Investig 2020; 25:187-193. [PMID: 32472254 DOI: 10.1007/s00784-020-03350-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/15/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The aim of this study was categorizing the microbial flora and susceptibility to antibiotics and to clarify to which degree the empiric administered antibiotics are suitable for therapy. MATERIALS AND METHODS A 3.5-year retrospective study evaluated hospital records of 206 patients who suffered from head and neck infections of odontogenic origin. All patients underwent surgical incision and drainage and received intravenous antibiotics and inpatient treatment. The specimens were obtained by performing a swab. RESULTS Two hundred six patients were included with 251 strains isolated (1.22 per patient). One hundred eight strains showed antibiotic resistance. Eighty-seven patients showed at least one bacterial strain that showed antibiotic resistance (42.2%). The most frequent isolated bacteria were Streptococcus spp. (n = 116), with a high rate of antibiotic resistance (50.8%). We investigated 205 cases of antibiotic resistance in 87 subjects. Nine bacterial strains showed no susceptibility to unacid (4.3%) and 36 strains to clindamycin (17.5%). CONCLUSION Antibiotic resistance against clindamycin was rather high. The distribution of the afflicted spaces and isolated bacteria was alike recent findings. It is mandatory to understand that immediate surgical treatment in terms of incision and drainage is the basis in abscess treatment. Antibiotic treatment is adjunct therapy. CLINICAL RELEVANCE Streptococcus species were the most frequently identified bacteria presenting antibiotic resistance in more than 50%. Increased resistant rates for clindamycin require reconsiderations regarding an empiric antibiotic treatment.
Collapse
Affiliation(s)
- Nils Heim
- Department of Oral & Maxillofacial Plastic Surgery, University Hospital Bonn, Venusberg Campus 1, Haus 11, 2. OG, D-53127, Bonn, Germany.
| | - Benedict Jürgensen
- Department of Oral & Maxillofacial Plastic Surgery, University Hospital Bonn, Venusberg Campus 1, Haus 11, 2. OG, D-53127, Bonn, Germany
| | - Franz-Josef Kramer
- Department of Oral & Maxillofacial Plastic Surgery, University Hospital Bonn, Venusberg Campus 1, Haus 11, 2. OG, D-53127, Bonn, Germany
| | - Valentin Wiedemeyer
- Department of Oral & Maxillofacial Plastic Surgery, University Hospital Bonn, Venusberg Campus 1, Haus 11, 2. OG, D-53127, Bonn, Germany
| |
Collapse
|
18
|
Indication for an additional postoperative antibiotic treatment after surgical incision of serious odontogenic abscesses. J Craniomaxillofac Surg 2020; 48:229-234. [PMID: 32111509 DOI: 10.1016/j.jcms.2020.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 12/03/2019] [Accepted: 01/22/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Serious abscesses of an odontogenic origin occur frequently in the oral and maxillofacial surgery departments. Rapid surgical incision and drainage constitutes the most important therapeutic action. However, additional surgical therapy and supplementary administration of antibiotics is often carried out, such that the efficiency of this supplementary therapeutic option has been questioned. METHODS All patients with severe odontogenic infections who received surgical treatment under general anaesthesia were recruited to this retrospective study. We determined whether they received additional antibiotic therapy on the ward and if it was possible to improve therapeutic outcomes using this option. RESULTS A total of 258 patients with a severe odontogenic infection between January 2008 and August 2014 were included. The most frequent infection observed was a submandibular abscess (56%), followed by a perimandibular abscess (18%) and a submental abscess (9%). About 65% of the patients were treated with antibiotics in addition to surgery. The median CRP level prior to surgical treatment was 87.8 mg/l (Q1: 40.3 mg/l; Q3: 143.5 mg/l) in patients who were administered an additional antibiotic and 83.8 mg/l (Q1: 37.3 mg/l; Q3: 135.0 mg/l) in those who received no antibiotic treatment after surgery. The postoperative median CRP levels were 116.5 mg/l (Q1: 52.1 mg/l; Q3: 159.3 mg/l) and 106.5 mg/l (Q1: 40.6 mg/l; Q3: 152.6 mg/l), respectively. Neither the preoperative CRP level (p = 0.546) nor the postoperative CRP level (p = 0.450) differed significantly between the groups. But patients who received additional antibiotic therapy had a significantly longer hospital stay (median: 6 days; range: 1-22 days) than patients who had no additional antibiotic therapy (median: 4 days; range: 1-19 days) (p = 0.002). CONCLUSIONS This study did not show an improvement in the therapeutic outcome with administration of supplementary antibiotics in addition to surgery. Thus, surgically incising an abscess is the most important therapeutic action and administration of antibiotics must be critically scrutinised.
Collapse
|
19
|
Deep neck space infections: an upward trend and changing characteristics. Eur Arch Otorhinolaryngol 2019; 277:863-872. [PMID: 31797041 PMCID: PMC7031181 DOI: 10.1007/s00405-019-05742-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 11/24/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE This study reviews our experience with deep neck space infections (DNIs) requiring surgical intervention, including cervical necrotizing fasciitis. The aim of the study was to identify predisposing and aggravating factors of the disease and recognize the possible factors that can lead to life-threatening complications and slow down the healing process. METHODS We compare the results to previous data from 1985 to 2005 to find possible alterations and changing trends. The characteristics of four lethal cases are described. This retrospective analysis includes patient data from 2004 to 2015 in tertiary referral hospital and in total, 277 patients were found. RESULTS Surgical drainage through a neck opening ± intraoral incision was made in 215 (77.6%) patients, an intraoral incision was only made in 62 patients (22.4%). ICU care was needed in 66 (23.8%) cases. Odontogenic etiology (44.8%) was the most common origin. The most common comorbidity was a psychiatric disorder and/or dementia and occurred in 55 (19.9%) patients. Patients with underlying illnesses were more likely to be admitted to the ICU (p = 0.020), required a longer ICU stay (p = 0.004) and repeated surgery (p = 0.009). Gas formation seemed to be predictive of a more severe course of infection. Early extraction of the odontogenic foci was related to a lower length of stay (LOS) (p = 0.039). CONCLUSION The annual numbers have risen from 14 to 24 cases per year when compared to previous data. DNIs remain a cause of lethal complications; the mortality was 1.4% and overall complications occurred in 61 (22.0%) patients.
Collapse
|
20
|
Loyola-Rodriguez JP, Franco-Miranda A, Loyola-Leyva A, Perez-Elizalde B, Contreras-Palma G, Sanchez-Adame O. Prevention of infective endocarditis and bacterial resistance to antibiotics: A brief review. SPECIAL CARE IN DENTISTRY 2019; 39:603-609. [PMID: 31464005 DOI: 10.1111/scd.12415] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/31/2019] [Accepted: 08/03/2019] [Indexed: 12/26/2022]
Abstract
The purpose of this statement is to debate the recommendations of the American Heart Association (AHA) for the prevention of infective endocarditis through an antibiotic prophylaxis protocol and its relation with bacterial resistance to antibiotics. Since dental infections involve biofilms that include several bacterial species (Gram-negative and Gram-positive), it is essential, from the dental point of view, to consider the frequency, magnitude, and duration of bacteremia associated with active dental infections before applying antibiotic prophylaxis. The actual guidelines for antibiotic prophylaxis should be revised according to recent evidence of bacterial resistance. Amoxicillin/clavulanic acid and moxifloxacin should be considered due to their effectiveness against bacteria associated with oral, GU, and GI infections and the low rates of antibiotic resistance associated with these antibiotics, instead of the actual protocol, which includes amoxicillin (2 g) or clindamycin (600 mg) administered an hour before the dental procedures. The breaking point to test the antibiotic bacterial resistance (ABR) had a wide range in the different studies that were analyzed, which could explain the widely varied ABR percentages reported for the various antibiotics used for antibiotic prophylaxis.
Collapse
Affiliation(s)
- Juan Pablo Loyola-Rodriguez
- Laboratorio de Biomateriales y Bionanotecnología, Maestría en Ciencias de la Salud, Facultad de Medicina, Universidad Autónoma de Guerrero, Acapulco, México
| | | | - Alejandra Loyola-Leyva
- Doctorado en Ciencias Biomedicas Básicas, Universidad Autónoma de San Luis Potosí, México
| | - Bulfrano Perez-Elizalde
- Medicina Translacional, Maestría en Ciencias de la Salud, Facultad de Medicina, Universidad Autónoma de Guerrero, Acapulco, México
| | - Guillermo Contreras-Palma
- Laboratorio de Biomateriales y Bionanotecnología, Maestría en Ciencias de la Salud, Facultad de Medicina, Universidad Autónoma de Guerrero, Acapulco, México
| | - Oscar Sanchez-Adame
- Medicina Translacional, Maestría en Ciencias de la Salud, Facultad de Medicina, Universidad Autónoma de Guerrero, Acapulco, México
| |
Collapse
|
21
|
Cagna DR, Donovan TE, McKee JR, Eichmiller F, Metz JE, Albouy JP, Marzola R, Murphy KR, Troeltzsch M. Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2019; 122:198-269. [PMID: 31405523 DOI: 10.1016/j.prosdent.2019.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 12/13/2022]
Abstract
This comprehensive review of the 2018 dental literature is provided to inform busy dentists about progress in the profession. Developed by the Committee on Scientific Investigation of the American Academy of Restorative Dentistry, each author brings discipline-specific expertise to one of the 8 sections of the report including (1) prosthodontics; (2) periodontics, alveolar bone, and peri-implant tissues; (3) implant dentistry; (4) dental materials and therapeutics; (5) occlusion and temporomandibular disorders; (6) sleep-related breathing disorders; (7) oral medicine and oral and maxillofacial surgery; and (8) dental caries and cariology. The report targets important information that will likely influence day-to-day treatment decisions. Each review is not intended to stand alone but to update interested readers so that they may visit source materials if greater detail is desired. As the profession continues its march toward evidence-based clinical decision-making, an already voluminous library of potentially valuable dental literature continues to grow. It is the intention of this review and its authors to provide assistance in navigating the extensive dental literature published in 2018. It is our hope that readers find this work useful in the clinical management of patients moving forward.
Collapse
Affiliation(s)
- David R Cagna
- Professor, Associate Dean, and Residency Director, Department of Prosthodontics, University of Tennessee Health Sciences Center, College of Dentistry, Memphis, Tenn.
| | - Terence E Donovan
- Professor and Head of Biomaterials, Department of Restorative Sciences, University of North Carolina School of Dentistry, Chapel Hill, NC
| | - James R McKee
- Private practice, Restorative Dentistry, Downers Grove, Ill
| | | | - James E Metz
- Private practice, Restorative Dentistry, Columbus, Ohio
| | - Jean-Pierre Albouy
- Assistant Professor, Department of Restorative Sciences, University of North Carolina School of Dentistry, Chapel Hill, NC
| | | | - Kevin R Murphy
- Associate Clinical Professor, Department of Periodontics, University of Maryland College of Dentistry, Baltimore, MD; Private practice, Periodontics and Prosthodontics, Baltimore, MD
| | | |
Collapse
|
22
|
Struyf T, Vandael E, Leroy R, Mertens K, Catry B. Antimicrobial prescribing by Belgian dentists in ambulatory care, from 2010 to 2016. Int Dent J 2019; 69:480-487. [PMID: 31376156 DOI: 10.1111/idj.12512] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To describe antimicrobial prescribing by Belgian dentists in ambulatory care, from 2010 until 2016. MATERIALS AND METHODS Reimbursement data from the Belgian National Institute for Health and Disability Insurance were analysed to evaluate antimicrobial prescribing (WHO ATC-codes J01/P01AB). Utilisation was expressed in defined daily doses (DDDs), and in DDDs and packages per 1000 inhabitants per day (DID and PID, respectively). Additionally, the number of DDD and packages per prescriber was calculated. RESULTS In 2016, the dentistry-related prescribing rate of 'Antibacterials for systemic use' (J01) and 'Antiprotozoals' (P01AB) was 1.607 and 0.014 DID, respectively. From 2010 to 2016, the DID rate of J01 increased by 6.3%, while the PID rate declined by 6.7%. Amoxicillin and amoxicillin with an enzyme inhibitor were the most often prescribed products, followed by clindamycin, clarithromycin, doxycycline, azithromycin and metronidazole. The proportion of amoxicillin relative to amoxicillin with an enzyme inhibitor was low. The narrow-spectrum antibiotic penicillin V was almost never prescribed. CONCLUSIONS Antibiotics typically classified as broad- or extended-spectrum were prescribed most often by Belgian dentists during the period 2000-2016. Although the DID rate of all 'Antibacterials for systemic use' (J01) increased over the years, the number of prescriptions per dentist decreased since 2013. The high prescription level of amoxicillin with an enzyme inhibitor is particularly worrying. It indicates that there is a need for comprehensive clinical practice guidelines for Belgian dentists.
Collapse
Affiliation(s)
- Thomas Struyf
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Sciensano, Healthcare-associated Infections & Antimicrobial Resistance, Brussels, Belgium
| | - Eline Vandael
- Sciensano, Healthcare-associated Infections & Antimicrobial Resistance, Brussels, Belgium
| | - Roos Leroy
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
| | - Karl Mertens
- Sciensano, Healthcare-associated Infections & Antimicrobial Resistance, Brussels, Belgium
| | - Boudewijn Catry
- Sciensano, Healthcare-associated Infections & Antimicrobial Resistance, Brussels, Belgium.,Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
| |
Collapse
|
23
|
Tent PA, Juncar RI, Onisor F, Bran S, Harangus A, Juncar M. The pathogenic microbial flora and its antibiotic susceptibility pattern in odontogenic infections. Drug Metab Rev 2019; 51:340-355. [PMID: 30999773 DOI: 10.1080/03602532.2019.1602630] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Suppurative head and neck infections of odontogenic origin are the most frequent type of head and neck infections. According to the literature, 7-10% of all antibiotics are currently prescribed for their treatment. Since penicillin was invented, the overall antibiotic sensitivity and resistance pattern of the isolated pathogenic microflora has continuously changed. The response of microorganisms to antibiotics and the development of resistance to their action is a purely evolutive process characterized by genetic mutations, acquisition of genetic material or alteration of gene expression and metabolic adaptations. All this makes challenging and difficult the correct choice of empirical antibiotic treatment for head and neck space infections even today. The aim of this paper was to evaluate the literature and to evidence the most frequent locations of odontogenic head and neck infections, the dominant pathogenic microbial flora, the genetic mutations and metabolic changes necessary for bacteria in order to aquire antibiotic resistance and as well its susceptibility and resistance to common antibiotics. We also aimed to highlight the possible changes in bacterial resistance to antibiotics over time, and to assess whether or not there is a need for fundamental changes in the empirical antibiotic treatment of these infections and show which these would be.
Collapse
Affiliation(s)
- Paul Andrei Tent
- Dental Medicine, Universitatea din Oradea Facultatea de Medicina si Farmacie , Oradea , Romania
| | - Raluca Iulia Juncar
- Dental Medicine, Universitatea din Oradea Facultatea de Medicina si Farmacie , Oradea , Romania
| | - Florin Onisor
- Department of Oral and Maxilo-Facial surgery and Radiology, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Simion Bran
- Department of Oral and Maxilo-Facial surgery and Radiology, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Antonia Harangus
- Spitalul Clinic de Pneumoftiziologie Leon Daniello Cluj-Napoca , Cluj-Napoca , Romania
| | - Mihai Juncar
- Dental Medicine, Universitatea din Oradea Facultatea de Medicina si Farmacie , Oradea , Romania
| |
Collapse
|
24
|
Katoumas K, Anterriotis D, Fyrgiola M, Lianou V, Triantafylou D, Dimopoulos I. Epidemiological analysis of management of severe odontogenic infections before referral to the emergency department. J Craniomaxillofac Surg 2019; 47:1292-1299. [PMID: 31331847 DOI: 10.1016/j.jcms.2019.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 04/29/2019] [Accepted: 05/04/2019] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The aims of the present study are to present the epidemiology and management of patients hospitalized with odontogenic infections in a major Greek hospital from 2015 to 2016 and to find out whether the basic principles of management of odontogenic infections were followed before referral to the emergency department of the Oral and Maxillofacial Surgery Clinic (OMFSED). METHODS A retrospective study of the patients hospitalized with odontogenic infections was performed, including management both prior and after referral to the OMFSED. RESULTS During the two-year period from 2015 to 2016, 102 patients, 54 men (52.9%) and 48 women (47.1%) were hospitalized with severe odontogenic infections. The most common space involved in severe odontogenic infections was the submandibular (52.9%), and in 31.4% of the patients multiple spaces were involved. The lower third molars were the most common cause (36.5%). In 83 patients (81.4%) the tooth causing the infection had not received any treatment whatsoever and in all cases (100%) no decision for early incision and drainage prior to the referral to the OMFSED was made. CONCLUSION The data presented reveal that the basic principles of management of odontogenic infections are not followed before referral of the patients to the OMFSED.
Collapse
Affiliation(s)
- Konstantinos Katoumas
- Department of Oral & Maxillofacial Surgery, General Hospital of Athens "G. Gennimatas", Leoforos Mesogion 154, 11527, Athens, Greece.
| | - Dimitrios Anterriotis
- Department of Oral & Maxillofacial Surgery, General Hospital of Athens "G. Gennimatas", Leoforos Mesogion 154, 11527, Athens, Greece.
| | - Maria Fyrgiola
- Department of Oral & Maxillofacial Surgery, General Hospital of Athens "G. Gennimatas", Leoforos Mesogion 154, 11527, Athens, Greece.
| | - Violetta Lianou
- Department of Oral & Maxillofacial Surgery, General Hospital of Athens "G. Gennimatas", Leoforos Mesogion 154, 11527, Athens, Greece.
| | - Dimitrios Triantafylou
- Department of Oral & Maxillofacial Surgery, General Hospital of Athens "G. Gennimatas", Leoforos Mesogion 154, 11527, Athens, Greece.
| | - Ioannis Dimopoulos
- Department of Oral & Maxillofacial Surgery, General Hospital of Athens "G. Gennimatas", Leoforos Mesogion 154, 11527, Athens, Greece.
| |
Collapse
|
25
|
López-González E, Vitales-Noyola M, González-Amaro AM, Méndez-González V, Hidalgo-Hurtado A, Rodríguez-Flores R, Pozos-Guillén A. Aerobic and anaerobic microorganisms and antibiotic sensitivity of odontogenic maxillofacial infections. Odontology 2019; 107:409-417. [PMID: 30758697 DOI: 10.1007/s10266-019-00414-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 01/27/2019] [Indexed: 12/21/2022]
Abstract
This study aimed to identify the aerobic and anaerobic causal microorganisms of odontogenic infections and their antibiotic sensitivity. Purulent exudates were taken from patients with odontogenic infections by transdermal puncture, and aerobic and anaerobic microorganisms were identified using biochemical tests. Susceptibility to antibiotics was tested using the Kirby-Bauer method; the inhibition halos were measured according to NCCLS, and based on the results, the microorganisms were classified as susceptible, intermediate or resistant to each antibiotic. Frequencies of species and percentages of resistance were calculated. The microorganisms associated with odontogenic infections were principally anaerobic (65.3% anaerobic vs. 35.7% aerobic), and the susceptibility to antibiotics was higher in anaerobic than in aerobic microorganisms. The majority of isolated microorganisms (82%) showed susceptibility to amoxicillin/clavulanic acid. The causal agents of odontogenic infections were anaerobic microorganisms, which exhibited high resistance to antibiotics.
Collapse
Affiliation(s)
- Emmanuel López-González
- Endodontics Posgraduated Program, Faculty of Dentistry, San Luis Potosí University, San Luis Potosí, SLP, Mexico
| | - Marlen Vitales-Noyola
- Endodontics Posgraduated Program, Faculty of Dentistry, San Luis Potosí University, San Luis Potosí, SLP, Mexico
| | - Ana María González-Amaro
- Endodontics Posgraduated Program, Faculty of Dentistry, San Luis Potosí University, San Luis Potosí, SLP, Mexico
| | - Verónica Méndez-González
- Endodontics Posgraduated Program, Faculty of Dentistry, San Luis Potosí University, San Luis Potosí, SLP, Mexico
| | - Antonio Hidalgo-Hurtado
- Department of Oral and Maxillofacial Surgery, Hospital "Ignacio Morones Prieto", San Luis Potosí, SLP, Mexico
| | - Rosaura Rodríguez-Flores
- Department of Oral and Maxillofacial Surgery, Hospital No. 50 of Mexican Social Security Institute, San Luis Potosí, SLP, Mexico
| | - Amaury Pozos-Guillén
- Basic Sciences Laboratory, Faculty of Dentistry, San Luis Potosi University, Zona Universitaria, Av. Manuel Nava 2, 78290, San Luis Potosí, SLP, Mexico.
| |
Collapse
|
26
|
A mathematical approach improves the predictability of length of hospitalization due to acute odontogenic infection: A retrospective investigation of 303 patients. J Craniomaxillofac Surg 2019; 47:334-340. [DOI: 10.1016/j.jcms.2018.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 10/18/2018] [Accepted: 12/04/2018] [Indexed: 11/19/2022] Open
|
27
|
The role of C-reactive protein and white blood cell count in the prediction of length of stay in hospital and severity of odontogenic abscess. J Craniomaxillofac Surg 2018; 46:2220-2226. [DOI: 10.1016/j.jcms.2018.10.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/15/2018] [Indexed: 11/20/2022] Open
|