Abstract
The in vitro antimicrobial susceptibility of 29 strains of the major periodontal pathogen Porphyromonas gingivalis and three P. gulae (as an ancestor) to nine antibiotics (amoxicillin, amoxicillin/clavulanate, clindamycin, metronidazole, moxifloxacin, doxycycline, azithromycin, imipenem, and cefoxitin) was evaluated by E-testing of minimal inhibitory concentration (MIC) according to international standards. The results were compared with 16 international studies reporting MICs from 1993 until recently. In addition, 77 currently available P. gingivalis genomes were screened for antimicrobial resistance genes. E-testing revealed a 100% sensitivity of P. gingivalis and P. gulae to all antibiotics. This was independent of the isolation year (1970 until 2021) or region, including rural areas in Indonesia and Africa. Regarding studies worldwide (675 strains), several method varieties regarding medium, McFarland inoculation standards (0.5–2) and incubation time (48–168 h) were used for MIC-testing. Overall, no resistances have been reported for amoxicillin + clavulanate, cefoxitin, and imipenem. Few strains showed intermediate susceptibility or resistance to amoxicillin and metronidazole, with the latter needing both confirmation and attention. The only antibiotics which might fail in the treatment of P. gingivalis-associated mixed anaerobic infections are clindamycin, macrolides, and tetracyclines, corresponding to the resistance genes erm(B), erm(F), and tet(Q) detected in our study here, as well as fluoroquinolones. Periodical antibiotic susceptibility testing is necessary to determine the efficacy of antimicrobial agents and to optimize antibiotic stewardship.
Highlights
Porphyromonas gingivalis is a non-motile, Gram-negative, rod-shaped/filamentous, anaerobic bacterium forming black-pigmented colonies after 3–4 days of incubation on supplemented blood agar plates
MIC90 were all in line with other studies conducted worldwide
No single strain of our collection reached resistance according to the breakpoints, so far defined by CLSI/EUCAST
Summary
Porphyromonas gingivalis is a non-motile, Gram-negative, rod-shaped/filamentous (pleomorphic), anaerobic bacterium forming black-pigmented colonies after 3–4 days of incubation on supplemented (vitamin K, hemin) blood agar plates. It is an opportunistic pathogenic bacterium, commonly found in the human body and especially in the oral cavity, where it is associated with periodontal diseases. It has been detected at various body sites, such as intra-abdominally [7], vaginal samples in cases of vaginosis [8], amniotic fluid [9], synovial specimens of rheumatoid arthritis and psoriatic arthritis [10], and together with some other periodontal organisms, in occluded arteries of the lower extremities of Buerger’s disease patients [11]. Investigated links between P. gingivalis and age-related macular degeneration [12], adverse pregnancy outcomes [13], Alzheimer’s disease [14,15], atherosclerotic disease [16], and cancer [17] need confirmation
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