The pathogenic microbial flora and its antibiotic susceptibility pattern in odontogenic infections

Epidemiological characteristics and risk factors for prolonged hospitalisation in oral and maxillofacial space infections: a 3-year retrospective study of 217 cases

BACKGROUND

Oral and maxillofacial space infections (OMSIs) are a serious emergency disease in oral and maxillofacial departments; untreated or undertreated OMSI can lead to serious complications and can be life-threatening. This study aimed to comprehensively analyse the epidemiological characteristics of OMSI, identify the associated etiological and risk factors, and develop a machine learning-based predictive model for factors influencing hospitalisation.

METHODS

Medical records of 217 patients hospitalised with OMSI were retrospectively analysed. Demographic data, clinical characteristics, treatment histories, microbiological profiles, and drug sensitivity test results were reviewed. A risk prediction model for hospitalisation length was established using machine learning.

RESULTS

Odontogenic infections (69.41%) were the most common etiological factors for OMSI, with periapical periodontitis being the most prevalent. Streptococcus spp. was the most frequently cultured aerobic bacteria, whereas Peptostreptococcus anaerobius was the predominant anaerobe. Drug sensitivity tests indicated high resistance rates to clindamycin and erythromycin among aerobic bacteria. The risk prediction model exhibited an area under the curve of 0.726 and was validated by an internal area under the curve of 0.712. Factors such as hypertension, diabetes, pre-admission interventions, and age were significantly associated with prolonged hospitalisation.

CONCLUSION

Periapical periodontitis remains a primary cause of OMSI; however, the rising incidence of infections due to cosmetic injections and implant surgeries warrants attention. Penicillin, clindamycin, and erythromycin are not recommended as empirical first-choice drugs. The predictive model effectively identified risk factors for extended hospitalisation. Hypertension, diabetes, pre-admission interventions, and age are risk factors for lengthened hospitalisation. Efforts should be made to promote oral hygiene education and healthcare system reforms in regions with similar demographic and socioeconomic conditions.

Associations of time to the operating room on outcomes in odontogenic infection

The purpose of this study was to determine if there were correlations between the length of time from hospital admission to surgical intervention and the frequency of complications in patients with odontogenic infections. While odontogenic infection is well studied in terms of interventions and outcomes, less is known about hospital utilization and resource burden of odontogenic infection with respect to timeliness to intervention. A retrospective cohort analysis was used to examine correlations between time from admission to surgical intervention and clinical outcomes. Patients included in this study were divided into three categories of length of time to the operating room: 0-12 h, 12.1-24 h, and greater than 24 h. Time of admission, time of surgical intervention, patient demographics, admission lab values, and space involvement were measured and compared to the primary outcome variables including complications of intubation attempts and type, ICU admission, length of hospitalization, number of changes in antibiotic therapy, and frequency of return to the operating room. We found that the length of time to the OR had a statistically significant association with length of hospital stay (p = 0.003) and number of changes in antibiotic therapy (p = 0.033). While overall length of hospital stay is inherently dependent on length of time to the OR, this relationship highlights the importance of timeliness to definitive intervention in order to reduce hospital burden. This study provides evidence on how to prioritize odontogenic infections in a hospital setting. We recommend treating odontogenic infection in less than 24 h from the time of admission in order to reduce costs and improve outcomes for patients.

Sulforaphane as a promising anti-caries agents: inhibitory effects on Streptococcus mutans and caries control in a rat model

Dental caries has been one of the most prevalent diseases globally over the last few decades, threatening human oral and general health. The most critical aspect in caries control is to inhibit the dominant cariogenic bacteria Streptococcus mutans (S. mutans). Sulforaphane (SFN), a compound found in a wide range of cruciferous plants, has demonstrated bacteriostatic activities against various pathogenic bacteria. The objective of the present study was to investigate the effects of SFN on S. mutans though both in vitro and in vivo experiment. The minimum inhibitory concentration (MIC) against S. mutans was determined at 256 μg/mL. The growth of S. mutans and the biofilm formation were inhibited by SFN in a dose-dependent manner through suppressing the synthesis of extracellular polysaccharide (EPS) and acid production, as well as decreasing the acid tolerance. Meanwhile, SFN significantly weakened the cariogenic properties of S. mutans at sub-inhibitory concentrations, which were further illustrated by quantitative real-time PCR (qRT-PCR). Moreover, SFN were found to inhibit quorum sensing (QS) by downregulate comCDE system in S. mutans. Further investigation using a rat caries model displayed a prominent caries control in the SFN-treated group with no observed toxicity. The notable results demonstrated in this study highlight the potential of SFN as a natural substitute for current anti-caries agents, while also providing valuable insights into the potential applications of SFN in caries control.

Microbial spectrum and resistance of odontogenic abscesses - microbiological analysis using next generation sequencing

OBJECTIVES

This study aimed to map the microbiome of odontogenic abscesses using next-generation sequencing (NGS) to identify bacterial and fungal species, as well as antibiotic resistances.

MATERIALS AND METHODS

Wound swabs were taken from patients treated for odontogenic abscesses at the Department of Oral and Maxillofacial Plastic Surgery, University Hospital Bonn. NGS was used to analyze the swabs, and bioinformatic analysis assigned the genetic material to microorganism profiles and identified antibiotic resistances.

RESULTS

Bacteria were detected in all samples from 51 patients. Anaerobes were found in 50 swabs, while aerobic bacteria were detected in 30. Four of the five most common bacterial genera were anaerobes (Fusobacterium, Prevotella, Parvimonas, Porphyromonas). A median of eight genera were identified per swab. Infections were mostly polymicrobial; only one case was a monoinfection with Streptococcus. Aerobic bacteria were less frequent in patients who had prior antibiotic therapy (p = 0.015). Fungi were present in 52.9% of cases, with Malassezia (33.3%), Aspergillus (9.8%), and Candida (3.9%) being the most common. Antibiotic resistance was detected in 66.7% of patients, mainly against lincosamides, macrolides and tetracyclines. Fusobacterium showed a 25.9% resistance rate to clindamycin.

CONCLUSIONS

The microbiome of odontogenic abscesses is polymicrobial, dominated by anaerobic bacteria, and more extensive than indicated by traditional cultural diagnostics. NGS provides detailed pathogen diagnostics, aiding in precise and individualized antibiotic therapy.

CLINICAL RELEVANCE

Improved understanding of the bacterial and fungal spectrum, along with current resistance patterns of odontogenic abscesses, is crucial for optimizing treatment outcomes. NGS offers rapid, accurate and detailed microbiome analysis, enhancing patient-specific therapeutic strategies.

Intra-oral Drainage of Submandibular Abscess: A Minimally Invasive Technique. A Prospective Study

PURPOSE

To evaluate the efficacy of intraoral drainage of isolated submandibular space abscess as a minimally invasive surgical technique compared to the standard trans-cervical approach.

PATIENTS AND METHODS

This prospective study included 40 subjects with isolated submandibular space abscesses. They were randomly divided into 2 equal groups: trans-cervical surgical drainage (group A) and intra-oral surgical drainage (group B). The included data were demographics, repeated surgery requirement, postsurgical hospitalization duration, formation of scar, and complications.

RESULTS

Intraoral drainage (Group B) reduced the mean operative time by 15.25 min (P < 0.001) compared with trans-cervical incision (Group A). No considerable difference was found between the 2 groups in regarding hospitalization postoperatively. No weakness in marginal mandibular nerve was found in both groups. Three patients only have a cervical scar in a group (B) who required external drainage due to recollection. No recurrence was detected in a group (A).

CONCLUSION

The current study demonstrated that isolated submandibular abscesses can be successfully managed with an intraoral drainage modality, and it is a better option than the trans-cervical approach regarding better cosmetic outcome and shorter operative time.

The In Vitro Assessment of Antibacterial and Antioxidant Efficacy in Rosa damascena and Hypericum perforatum Extracts against Pathogenic Strains in the Interplay of Dental Caries, Oral Health, and Food Microbiota

The rising demand for novel antibiotic agents prompts an investigation into natural resources, notably plant-derived compounds. In this study, various extracts (aqueous, ethanolic, aqueous-ethanolic, and enzymatic) of Rosa damascena and Hypericum perforatum were systematically evaluated against bacterial strains isolated from dental lesions (n = 6) and food sources (raw milk and broiler carcass, n = 2). Minimal inhibitory concentration (MIC), minimal bactericidal concentration (MBC), antibiofilm activity, and time-kill kinetics were assessed across a range of extract concentrations, revealing a dose-responsive effect. Notably, some extracts exhibited superior antibacterial efficacy compared to standard clinical antibiotics, and the time-kill kinetics demonstrated a rapid elimination of bacterial loads within 24 h. The susceptibility pattern proved strain-specific, contingent upon the extract type, yet all tested pathogens exhibited sensitivity. The identified extracts, rich in phenolic and polyphenolic compounds, as well as other antioxidant properties, contributed to their remarkable antibiotic effects. This comprehensive investigation not only highlights the potential of Rosa damascena and Hypericum perforatum extracts as potent antibacterial agents against diverse bacterial strains including caries pathogens, but also underscores their rapid action and dose-dependent efficacy. The findings suggest a promising avenue for harnessing plant-derived compounds in the development of novel antimicrobial strategies against dental caries and other oral inflammations, bridging the gap between natural resources and antibiotic discovery.

Identification of Pathogenic Microflora and Its Sensitivity to Antibiotics in Cases of the Odontogenic Purulent Periostitis and Abscesses in the Oral Cavity

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.

Natural products from traditional medicine as promising agents targeting at different stages of oral biofilm development

Oral cavity is an ideal habitat for more than 1,000 species of microorganisms. The diverse oral microbes form biofilms over the hard and soft tissues in the oral cavity, affecting the oral ecological balance and the development of oral diseases, such as caries, apical periodontitis, and periodontitis. Currently, antibiotics are the primary agents against infectious diseases; however, the emergence of drug resistance and the disruption of oral microecology have challenged their applications. The discovery of new antibiotic-independent agents is a promising strategy against biofilm-induced infections. Natural products from traditional medicine have shown potential antibiofilm activities in the oral cavity with high safety, cost-effectiveness, and minimal adverse drug reactions. Aiming to highlight the importance and functions of natural products from traditional medicine against oral biofilms, here we summarized and discussed the antibiofilm effects of natural products targeting at different stages of the biofilm formation process, including adhesion, proliferation, maturation, and dispersion, and their effects on multi-species biofilms. The perspective of antibiofilm agents for oral infectious diseases to restore the balance of oral microecology is also discussed.

A Five-Year Retrospective Study of 746 Cases with Maxillofacial Space Infection in Western China

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.

Cefazolin versus ampicillin/sulbactam as an empiric antibiosis in severe odontogenic neck infection descending from the lower jaw-retrospective analysis of 350 cases

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.