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.
Highlights
The oral flora, alongside the gastrointestinal microbiome, is one of the most diverse accumulations of microorganisms in the human body
The majority of clinical isolates were derived from female patients, while in hospitals, isolates were mainly collected from male patients
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
Summary
The oral flora, alongside the gastrointestinal microbiome, is one of the most diverse accumulations of microorganisms in the human body. (Aas et al, 2005; Dewhirst et al, 2010), which can cause dental and oral-maxillofacial infections under certain conditions, such as caries, periodontitis, endodontic infections and tonsillitis (Scannapieco, 2013; Wade, 2013; Døving et al, 2020). In addition to these commensals, other bacterial pathogens are associated with infections of the oral cavity, such as Staphylococcus spp. According to the World Health Organization (WHO), many of the bacterial microorganisms associated with dental and oral-maxillofacial infections are associated with resistance to antibiotics (Tacconelli et al, 2018). Antibiotic-resistant bacteria are associated with a significant mortality and morbidity (Cassini et al, 2019) and pose a severe health threat worldwide (WHO, 2014)
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