Abstract
ObjectivesThe aim of our study was to describe microbial flora associated with MRONJ and characterize the susceptibility of pathogens to help guide an effective empiric antibiotic treatment in these patients.Materials and methodsA retrospective, single-center analysis was performed, using 116 bone samples from 98 patients. The bone samples were homogenized and subjected to routine culture methods. Growing bacteria were differentiated to the species level using whole-cell mass spectrometry and subjected to susceptibility testing.ResultsA highly diverse microbial flora was detected in necrotic bone, with a simultaneous presence of two or more bacterial species in 79% of all patients. In at least 65% of samples, gram-negative isolates were detected. Therefore, bacterial species resistant against β-lactamase inhibitors were present in at least 70% of all patients.ConclusionsThe empiric choice of antibiotics in MRONJ patients should consider the high rate of gram-negative bacteria and resistance against β-lactam antibiotics.Clinical relevanceAccording to recent guidelines and recommendations, systemic antibiotic treatment is a key component in the treatment of all stage 2 and 3 MRONJ patients. We recommend using fluoroquinolones for empiric treatment and emphasize the use of bacterial cultivation and susceptibility testing to enable an effective antibiotic treatment.
Highlights
Antiresorptive drug induced- or medication-related osteonecrosis of the jaw (ARONJ, MRONJ) became a serious disease pattern in recent years
Between June 2016 and September 2018, 98 patients treated at the University Medical Center Eppendorf for clinically and histopathologically confirmed osteonecrosis of the jaw were included in this study (Table 1)
Cultivation revealed no bacterial growth in three cases
Summary
Antiresorptive drug induced- or medication-related osteonecrosis of the jaw (ARONJ, MRONJ) became a serious disease pattern in recent years. The number of patients receiving intravenous (e.g., zoledronate) or oral bisphosphonates (e.g., alendronate) [1] as well as subcutaneous treatment with RANKL inhibitors (e.g., denosumab) or compounds with antiangiogenic effects (i.e., bevacizumab, sorafenib, sunitinib, and others) have been rising over the last decade [2,3,4]. The estimated cumulative incidence of MRONJ in patients receiving bisphosphonates or RANKL inhibitors. The diagnostic criteria of MRONJ include an exposure history to bisphosphonates, RANKL inhibitors, or antiangiogenic drugs, exposed bone within the oral cavity, and no history of prior radiation therapy to the jaws [11]. To a detailed intraoral examination, initial diagnostic procedures routinely include X-ray analysis (e.g., panoramic view, cone beam computed tomography, or computed tomography scans) [12, 13], as well as magnetic resonance imaging (MRI) and scintigraphy [14]
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