Abstract
Objective: The aim of this study was to evaluate the minimal inhibitory concentrations (MIC) of different antibiotic agents against to the most prevalent microorganism found in root-filled canals by culture and molecular approaches. Material and Methods: The microbial samples were taken either from thirty root-filled canals after removal of gutta-percha. Culture methods and 16s rDNA assay were used to identify the E faecails present in the samples. The antimicrobial susceptibilities of the isolates of E faecalis were determined by MIC values using the E test System and interpreted according to the Clinical and Laboratory Standards Institute guidelines. The following antibiotics were used: benzylpenicillin, amoxicillin, amoxicillin-clavulanic acid, erythromycin, azithromycin, vancomycin, chloramphenicol, tetracycline, doxycycline, ciprofloxacin, rifampicin and moxifloxacin. Results: E faecalis were isolated (7/30) and detected (13/30) by culture and PCR assay, respectively. All tested E faecalis (n=12) were highly sensitive to amoxicillin, moxifloxacin, vancomycin, benzylpenicillin and amoxicillin-clavulanic acid. Some antibiotics were resistant against E faecalis strains such as rifampicin (4/12), tetracycline (2/12), doxycycline (1/12), erythromycin (3/12) and azythromycin (8/12). Conclusion: Amoxicillin, amoxicillin-clavulanic acid, benzylpenicillin, vancomycin and moxifloxacin were the most active antibiotics, in vitro, against E faecalis clinical strains, with all the isolates being susceptible. Azithromycin and erythromycin were least effective, with none percentage of isolates being susceptible, during laboratory testing. Moreover, E faecalis were identified more frequently by PCR assay than by culture technique.Keywords: Retreatment; Antibiotics, antimicrobial susceptibility; Enterococcus faecalis; Antibiotic resistance.
Highlights
Endodontic infections are polymicrobial involving a combination of Gram-positive, Gram-negative, facultative anaerobes and strict anaerobic bacteria [1]
Bacterial cultures and molecular studies have confirmed that Enterococcus faecalis is one of the most prevalent bacteria found in the root canal after endodontic treatment [3,4]
Enterococcus faecalis were found in seven cases after root canal filling removal by culture technique, while in thirteen cases E faecalis were detected by using 16S rDNA PCR
Summary
Endodontic infections are polymicrobial involving a combination of Gram-positive, Gram-negative, facultative anaerobes and strict anaerobic bacteria [1]. The bacteria remaining in the root canal system after endodontic treatment cause secondary, or persistent, infections [2]. These microorganisms may have survived to the biomechanical procedures or invaded the canal via coronal leakage of the root filling. Bacterial cultures and molecular studies have confirmed that Enterococcus faecalis is one of the most prevalent bacteria found in the root canal after endodontic treatment [3,4]. Enterococci frequently cause a wide variety of infections in humans and it has been implicated in endodontic infections [5]. E faecalis are frequently isolated from obturated root canals of teeth that exhibit chronic periapical pathology [6]. E faecalis, intrinsically or via acquisition, may be resistant to a wide range of antibiotics [7,8], which, if used, may shift the microbiota in favor of E faecalis
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