Abstract
The periodontal microbiota is ecologically diverse and may facilitate colonization by bacteria of enteric origin (Enterobacteriaceae, Enterococci) and co-infections with Candida albicans, possibly producing subgingival biofilms with high antimicrobial tolerance. This retrospective surveillance study followed periodontitis-associated superinfection profiles in a large patient sample. From 2008 to 2015, biofilm samples from deep periodontal pockets were collected from a total of 16,612 German adults diagnosed with periodontitis. The presence of selected Enterobacteriaceae, Enterococci, and Candida albicans was confirmed in overnight cultures. Antimicrobial susceptibility of these clinical isolates was tested by disk diffusion with antibiotics routinely used for treatment of oral infections, e.g., amoxicillin (AML), amoxicillin/clavulanic acid (AMC), doxycycline (DO), and ciprofloxacin (CIP). The mean annual prevalence of patients harboring Enterobacteriaceae in periodontal plaques was 11.5% in total and ranged from 2.5% for Enterobacter cloacae to 3.6% for Klebsiella oxytoca, 1.1% for Klebsiella pneumoniae, 2.8% for Serratia marcescens, and 1.5% for Serratia liquefaciens. In comparison, the mean detection rates for microbiota typically found in the oral cavity were higher, e.g., 5.6% for Enterococcus spp. and 21.8% for Candida albicans. Among the Enterobacteriaceae, species harboring intrinsic resistance to AML (Enterobacter spp., Klebsiella spp., Serratia spp.) were predominant. Non-susceptibility to AMC was observed for Serratia spp. and Enterobacter cloacae. By contrast, Enterococcus spp. only showed non-susceptibility to DO and CIP. Trends for increasing resistance were found to AML in Serratia liquefaciens and to DO in Enterococcus spp. Trend analysis showed decreasing resistance to AMC in Serratia liquefaciens and Klebsiella oxytoca; and to DO in Serratia marcescens, liquefaciens, and Enterobacter cloacae. This study confirms the low but consistent presence of Enterobacteriaceae and Enterococci among the subgingival microbiota recovered from periodontitis specimen. Although their pathogenetic role in periodontal lesions remains unclear, their presence in the oral cavity should be recognized as a potential reservoir for development and spread of antibiotic resistance in light of antibiotic usage in oral infections.
Highlights
The periodontal microbiota is ecologically diverse and may facilitate colonialization of species that are not usually part of the oral microbiota [1]
Most Enterobacteriaceae isolates collected from 16,000 German periodontitis patients displayed resistance to the antibiotics tested suggesting at least partial inefficacy of adjunctive antibiotic therapy with amoxicillin or doxycycline frequently used in periodontitis, if Enterobacteriaceae actively contributed to infection
It remains to be clarified whether the presence of Enterobacteriaceae in periodontal pockets is indicative of infection, contributes to disease course, or rather serves as a microbiological placeholder following antibiotic treatment and destruction of oral microbiota
Summary
The periodontal microbiota is ecologically diverse and may facilitate colonialization of species that are not usually part of the oral microbiota [1]. Enterococci, for example, are considered as transient constituent components of the oral microbiome and it is well known that they can cause or contribute to a variety of oral and systemic infections including urinary tract, blood stream, and wound infections, or endocarditis [2–5]. They have been recognized as nosocomial pathogens, mainly due to the increasing emergence of antimicrobial resistance phenotypes [6,7] and their capacity to form biofilms. Opportunistic microbiota, such as Enterococci and key periodontal pathogens, are conjointly recovered from periodontal pockets [12,13], suggesting a role for oral commensals in periodontal tissue destruction
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