Abstract
A prospective study of 130 patients attending the Government Dental and Maxillofacial Hospital (now Maxillofacial unit, Rivers State University Teaching Hospital), Port Harcourt, between August 2018 and September 2019. To examine the factors that affect the occurrence of a bacteremia associated with oral and maxillofacial surgical procedures, and the types of bacteria causing this bacteremia, and establish the need or otherwise for prophylactic antibiotics in, 'at risk' patients. 130 healthy adult patients requiring various oral and maxillofacial surgical procedures under local anesthesia using 2% lidocaine with 1: 100,000 adrenaline, were screened bacteriologically to determine the occurrence of a bacteremia. 5 milliliters of venous blood was collected from the antecubital vein of each patient preoperatively and within 3 minutes postoperatively. The samples collected were cultured and bacteriological identification done and analyzed. Bacteremia was found in 43 (33.1%) of 130 patients postoperatively. In patients undergoing extractions, bacteremia occurred more frequently when teeth were extracted due to inflammatory dental diseases. There was no statistical correlation between the occurrence of a bacteremia and the number of teeth extracted (p>0.05). Of the 70 isolates obtained postoperatively, 5 (6.4%) were aerobes, 51 (65.4%) were facultative anaerobes (including microaerophiles) and 14 (17.9%) were anaerobes. Among the facultative anaerobes (including microaerophiles), the most frequently isolated bacteria genera were species of Staphylococcus (25.7%), Streptococcus spp. (17.1%) and Streptococcus viridans (15.7%) and among the anaerobes, Bacteriodes spp. (8.6%) were the most frequently isolated. All the isolates were sensitive to azithromycin, amikacin, imipenem and meropenem. However, 3 (30%) of the isolates were resistant to amoxicillin, which is a commonly used drug for antimicrobial prophylaxis. This study shows the occurrence of bacteremia in Nigerians following various oral and maxillofacial surgical procedures and that the observed bacteremia was not dependent on the patient's age or gender. This study emphasizes the need for antibiotic prophylaxis in those patients who are at risk of developing complications from bacteremia. Amoxicillin as this study shows will not be an effective antibiotic prophylactic agent in a majority of patients. The author therefore recommends the use of azithromycin as an alternative prophylactic agent in those patients.
Highlights
The presence of bacteria in the blood stream is referred to as bacteremia
In individuals with congenital or acquired heart disease or those fitted with a valvular prosthesis, circulating bacteria may reach the defective endocardium and cause bacterial endocarditis[8]
This contrasts the findings of Okabe et al.[3]. They found a significantly higher occurrence of a bacteremia when the duration of the procedure lasted more than 100 minutes, than in shorter durations of operation. This is perhaps due to the fact that those procedures that took longer to complete, and that theoretically would have caused more tissue damage, and more bacteremia were less likely to be infected with the consequent effect of fewer bacteria introduced into the blood stream
Summary
The presence of bacteria in the blood stream is referred to as bacteremia. The blood stream is generally considered a sterile environment. Bacteria nutrients are plentiful in blood, major anti-microbial defenses, which include the circulating neutrophils and monocytes capable of phagocytosis, and the supporting components of humoral immunity including complements and immunoglobulins, help to mop up any bacteria that enter the blood stream.[1]. The oral environment is colonized by a number of species of bacteria, residing therein as commensals. They include anaerobes such as Peptostreptococcus, Propionibacterium, Bacteriodes, Prevotella and Fusobacterium spp., as well as facultative anaerobes such as Streptococcus, Actinomyces and Staphylococcus spp.[2,3,4,5]. Dental extractions have been documented to cause
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