Orofacial Odontogenic Infections Research Articles

Multivariate Analysis on Orofacial Odontogenic Infection in Northern Peninsular Malaysia

This regional 2-center study was designed 1) to analyze the clinical features of all patients with odontogenic orofacial infection as per type of visit, 2) to analyze the clinical features of diabetic patients compared with nondiabetic patients, and 3) to identify potential variables that may associate with long length of stay (LOS) of patients admitted for orofacial odontogenic infection in Northern Peninsular Malaysia. All adult patients with orofacial odontogenic infections who attended the Oral and Maxillofacial Department of Hospital Raja Permaisuri Bainun and Hospital Sultan Abdul Halim from March 2015 to February 2019 were included. Data on patients' demography, medical history, smoking status, clinical presentation, and LOS were collected. Multivariate logistic regression analysis was performed using the dichotomous dependent variable, namely, short LOS (LOS <5days) and long LOS (LOS ≥5days). A total of 355 patients were reported with the mean age of 39.93±15.95years old. Multivariate analysis revealed that diabetes (adjusted odds ratio=4.387, 95% confidence interval=1.453 to 13.241, Pvalue=.009) and multiple space involvement (adjusted odds ratio=4.859, 95% confidence interval=1.280, 18.454, P value=.020) were responsible for long LOS. Judicious treatment is recommended when treating patients of such infection that involves multiple spaces with underlying diabetes mellitus.

Clinical Management of Orofacial Odontogenic Infection: A Four Year Retrospective Study

Orofacial odontogenic infection, although arises from dental origin, can extend into the facial spaces and lead to debilitating complications. This study analysed the clinical pattern and management of orofacial odontogenic infection in a tertiary hospital namely Hospital Raja Permaisuri Bainun in Perak, Malaysia. We investigated any associations between socio-demographic factors, diabetic, comorbidities, smoking, pregnancy, antibiotic resistance, number and type of space infected towards prolonged hospital stay. All adult patients with orofacial odontogenic infections treated by Department of Oral and Maxillofacial Surgery from 2014 to 2018 were included. Clinical patterns were evaluated. Statistical analysis was performed to measure various variables towards prolonged hospital stay. A total of 154 patients (78 male, 76 female) were included in this study with mean age of 37.95 ± 14.9 years. Key factors of orofacial odontogenic infection requiring admissions were swelling, pain, trismus, odynophagia, reduced oral intake, raised floor of mouth and dyspnea. Among inpatients, three factors were significantly associated with prolonged hospital stay, namely antibiotic resistance, multiple space and secondary space infection. Local prevalence data was reported. Pus culture and sensitivity tests were recommended for all inpatients with multiple space and secondary space involvement, in order to rule out antibiotic resistance and to improve recovery rate.

Bacteriology of orofacial space infections-A retrospective study

Aim: The purpose of this study was to assess causative micro-organisms responsible for Orofacial space infections of odontogenic origin, and to evaluate their sensitivity to various antibiotics used in the treatment of these infections. Methods: The bacteriology and antimicrobial susceptibility of major pathogens in 30 patients with orofacial odontogenic infections were examined excluding the patients who were on prior antibiotic therapy, who were diagnosed to be immunocompromised and the patients were on immunosuppressants and the following patients underwent incision and drainage and received IV antibiotics. Results: A total of 46 bacterial strains were isolated from 30 patients out of which five patients' culture results were sterile. The most common aerobic bacteria isolated were Viridans Streptococci, Klebsiella Pneumonia and Streptococcus Pyogens, and anaerobic bacteria were Porphyromonas Gingivalis, Streptococci, Fusobacterium and Prevotella Melanogenicus. As per our study, Gentamycin (84%) and Cefotaxime (80%) were the most effective antibiotics. Conclusion: In conclusion, the surgical treatment incision and drainage must always be in the foreground for the therapy of orofacial space infections of odontogenic origin. Cultures and sensitivities commonly showed greater growth in aerobes (76%) than in anaerobes (23.9%).

Epidemiology, Microbiology and Antibiotic Sensitivity of Odontogenic Space Infections in Central India.

Odontogenic infections are the most commonly encountered orofacial infections, which may spread into the adjacent anatomical spaces along the contiguous fascial planes, leading to involvement of multiple spaces which can progress to life-threatening situations. A prospective study was carried out on 100 consecutive cases of odontogenic infections treated at our institute over a period of 18months by surgical intervention and intravenous antibiotics. Morphologic study of the isolates and antibiotic sensitivity testing was performed. Caries was the most frequent dental disease (53.27%), and the mandibular first molar was the most frequently involved tooth (41.9%) associated with the etiology of odontogenic infections. A total of 158 spaces were involved in 100 patients. In subjects with single space odontogenic infections (n=61), submandibular space was most commonly affected (44.26%) followed by buccal space (27%). In subjects with multiple space infections (n=39), submandibular space (30.19%) was most frequently involved followed by buccal space (17.92%). In the aerobic group/microaerophilic group, 17 different species were isolated in a total of 102 aerobic isolates. A total of 18 species were identified in 65 anaerobic isolates sampled. Amoxicillin possess antimicrobial activity against major pathogens in orofacial odontogenic infections, but β-lactamase production has restricted the effectiveness of amoxicillin against the resistant strains of Staphylococcus aureus, Bacteroides, Prevotella and Porphyromonas. For the management of orofacial infections, the use of amoxicillin/clavulanate and clindamycin is recommended because of stability against β-lactamases.

Antimicrobial Susceptibility of Microorganisms Isolated from Periapical Periodontitis Lesions.

Periapical periodontitis usually results from microbial infection, with these microorganisms occasionally migrating to the root canal, which can lead to further, potentially life-threatening, complications. Here, the susceptibility of 27 bacterial strains to various antimicrobial agents was evaluated. These strains comprised 13 species; 16 of the strains were clinical isolates from periapical lesions. Each strain was inoculated onto blood agar plates containing one of the antimicrobial agents. The plates were incubated anaerobically at 37°C for 96 hr and the minimal inhibitory concentrations (MICs) determined. Ten strains required an MIC of 32 μg/ml or greater for amoxicillin, 6 for cefmetazole, and 5 for cefcapene among β-lactam antibiotics; 8 strains required an MIC of 32 μg/ml or greater for clindamycin, 4 for azithromycin, and 11 for clarithromycin among macrolide antibiotics; 3 strains required an MIC of 32 μg/ml or greater for ciprofloxacin and 2 for ofloxacin among fluoroquinolones. The effect of cefcapene on 5 strains was evaluated after biofilm formation to investigate the relationship between biofilm formation and susceptibility. All strains showed a decrease in susceptibility after biofilm formation. The results revealed that several antimicrobial agents commonly used in a clinical setting, including amoxicillin, cefmetazole, and clindamycin, are potentially effective in the treatment of orofacial odontogenic infections. The development of resistant strains, however, means that this can no longer be guaranteed. In addition, azithromycin, ciprofloxacin, and ofloxacin were more effective than the 3 β-lactam antibiotics tested. These results suggest that sensitivity testing is needed if odontogenic infections are to be treated safely and effectively.

Microflora of Orofacial Space Infections of Odontogenic Origin in Children – A Bacteriological Study

Objectives: To investigate the causative micro-organisms and also to assess the anatomic distribution of orofacial space infections of odontogenic origin in pediatric patients. Materials and methods: A total of 25 patients, aged 3-14 years with orofacial odontogenic infections were selected and pus was collected using 22 gauge needles. The pus samples were immediately processed for Gram staining, aerobic and anaerobic cultures. Various parameters like gender, age, micro-organisms isolated and involved facial spaces were studied. Results: From 25 patients, total of 23 (92%) bacterial strains were isolated. In 2 (8%) patients no growth from cultures was observed. Among 23 isolates, 13 (56%) isolates were of mixed growth, 8 (34%) isolates of anaerobic growth and only 2 (8%) isolates of aerobic growth. Most commonly isolated aerobic species was Streptococcus viridans (47%). Peptostreptococcous (48%) was the most commonly isolated anaerobic species. The submandibular space (56%) was the most frequently involved space among single space infections. Involvement of multiple spaces was not observed. Conclusion: Pediatric orofacial space infections of odontogenic origin are a polymicrobial, mixed (aerobic – anaerobic) infection with predominance of anaerobic bacteria. Submandibular space is the most frequently involved space in children.

Evaluation of microbial flora in orofacial space infections of odontogenic origin

Background:The microbiology of acute dental infections has been in the midst of many researches. Various bacteriological studies show variations in their conclusion. The purpose of our study was to evaluate the microbial flora in orofacial space infections of odontogenic origin, which is essential for appropriate antibiotic selection.Materials and Methods:Thirty-five patients with odontogenic infection causing fascial space involvement were included. Aspirated specimen was transported in nutrient broth and thyoglycollate media within an hour for further culture and sensitivity testing.Result and Conclusion:This study indicates that orofacial odontogenic infections are usually polymicrobial, consisting of a complex mixture of both anaerobes and aerobes.

Molecular Methods for Diagnosis of Odontogenic Infections

Historically, the identification of microorganisms has been limited to species that could be cultured in the microbiology laboratory. The purpose of the present study was to apply molecular techniques to identify microorganisms in orofacial odontogenic infections (OIs). Specimens were obtained from subjects with clinical evidence of OI. To identify the microorganisms involved, 16S rRNA sequencing methods were used on clinical specimens. The name and number of the clones of each species identified and the combinations of species present were recorded for each subject. Descriptive statistics were computed for the study variables. Specimens of pus or wound fluid were obtained from 9 subjects. A mean of 7.4 ± 3.7 (standard deviation) species per case were identified. The predominant species detected in the present study that have previously been associated with OIs were Fusobacterium spp, Parvimonas micra, Porphyromonas endodontalis, and Prevotella oris. The predominant species detected in our study that have not been previously associated with OIs were Dialister pneumosintes and Eubacterium brachy. Unculturable phylotypes accounted for 24% of the species identified in our study. All species detected were obligate or facultative anaerobes. Streptococci were not detected. Molecular methods have enabled us to detect previously cultivated and not-yet-cultivated species in OIs; these methods could change our understanding of the pathogenic flora of orofacial OIs.

Evaluation of bacterial spectrum of orofacial infections and their antibiotic susceptibility

Introduction:The inappropriate use of antibiotics has contributed to a worldwide problem of antimicrobial resistance. The objective of present study is to assess the most common microorganisms causing orofacial infections and their antimicrobial susceptibility to routinely used antibiotics in this part of India.Materials and Methods:Sixty eight patients with orofacial infection were selected on the basis of a series of predefined inclusion and exclusion criteria. Samples were collected under aseptic conditions and subjected to culture and antibiotic susceptibility testing. Descriptive statistics were provided.Results:A total of 64 aerobic and 87 anaerobic strains were isolated. The predominant bacteria were Streptococci viridans (64%), Prevotella (43%), Peptostreptococcus (26%), Porphyromonas (7%), and Fusobacterium (14%). The isolated strains seemed to be highly sensitive to the routinely used antibiotics such as amoxicillin – clavulanate and amoxicillin alone, clindamycin, and levofloxacin. In contrast, more resistance to erythromycin was observed.Conclusion:Amoxicillin still possesses powerful antimicrobial activity against major pathogens in orofacial odontogenic infections. Amoxicillin/clavulanate and clindamycin would also be advocated as being useful alternatives for the management of severe orofacial infections. However, the findings of this study indicate that erythromycin is of questionable benefit in the treatment of severe orofacial odontogenic infections.

The clinical significance of anaerobic bacteria in acute orofacial odontogenic infections

A review of the literature on orofacial odontogenic infections indicates that the underlying microflora is typically polymicrobial, predominantly involving strictly anaerobic gram-positive cocci and gram-negative rods, along with facultative and microaerophilic streptococci. Although no single species has been consistently implicated in all of these infections, the pathogenic potential of some of these organisms has been documented by many studies. This potential can be explained by a number of virulence factors demonstrated in anaerobic bacteria, as well as by synergistic interrelationships with other members of the infectious flora. Awareness of the anaerobic component of orofacial odontogenic infections dictates to a large extent the selection of antimicrobial therapy, mainly because of the frequency of β-lactamase production by anaerobic gram-negative rods.

Poster 4: antibiotic therapy of odontogenic infections—renaissance of penicillins?

Poster 4: antibiotic therapy of odontogenic infections—renaissance of penicillins?

Antimicrobial susceptibility of major pathogens of orofacial odontogenic infections to 11 beta-lactam antibiotics.

In this study, we evaluated the current effectiveness of 11 beta-lactam antibiotics for treatment of orofacial odontogenic infections by determining the antimicrobial susceptibility of the major pathogens. The antimicrobial susceptibilities of viridans streptococci (n = 47), Peptostreptococcus (n = 67), Porphyromonas (n = 18), Fusobacterium (n = 57), black-pigmented Prevotella (n = 59) and non-pigmented Prevotella (n = 47) isolated from pus specimens of 93 orofacial odontogenic infections to penicillin G, cefmetazole, flomoxef, cefoperazone, cefoperazone/sulbactam, ceftazidime, cefpirome, cefepime, cefoselis, imipenem and faropenem were determined using the agar dilution method. Penicillin G, most cephalosporins, imipenem and faropenem worked well against viridans streptococci, Peptostreptococcus, Porphyromonas and Fusobacterium. Penicillin G and most cephalosporins, including fourth-generation agents, were not effective against beta-lactamase-positive Prevotella, though they were effective against beta-lactamase-negative strains. Cefmetazole, cefoperazone/sulbactam, imipenem and faropenem expressed powerful antimicrobial activity against beta-lactamase-positive Prevotella. In conclusion, penicillins have the potential to be first-line agents in the treatment of orofacial odontogenic infections. Most of the other beta-lactam antibiotics, including fourth-generation cephalosporins, were not found to have greater effectiveness than penicillins. In contrast, cefmetazole, cefoperazone/sulbactam, imipenem and faropenem were found to have greater effectiveness than penicillins.

Bacteriology and antimicrobial susceptibility of gram-positive cocci isolated from pus specimens of orofacial odontogenic infections.

We recently reported the beta-lactamase production and antimicrobial susceptibility of anaerobic gram-negative rods isolated from pus specimens of 93 orofacial odontogenic infections. In this report, we determine the bacteriology and antimicrobial susceptibility of bacteria other than anaerobic gram-negative rods, mainly gram-positive cocci, isolated from the same specimens. Streptococcus constellatus and Peptostreptococcus micros were frequent isolates from all types of infection examined. Peptostreptococcus prevotii, Corynebacterium species, and Eubacterium species were recovered only from dentoalveolar infections, while Gemella morbillorum was found more frequently in periodontitis than in the other infections. beta-Lactamase-positive strains were detected only in staphylococci. Ampicillin, ampicillin/sulbactam, cefazolin, cefotaxime, imipenem, erythromycin, clindamycin and levofloxacin showed high susceptibility rates (> or = 77%) against viridans streptococci, Peptostreptococcus and Gemella. Minocycline showed a high MIC90 value against viridans streptococci (32 microg/ml), and metronidazole was effective against Peptostreptococcus and Gemella. These results provide useful information for the treatment of orofacial odontogenic infections.

顎口腔領域歯性感染症から分離されるＰｒｅｖｏｔｅｌｌａ属のβ‐ラクタマーゼ産生性とβ‐ラクタム系抗菌薬に対する感受性についての検討

Orofacial odontogenic infections are usually treated with a β-lactam antibiotic. Most majorpathogens are susceptible to β-lactam antibiotics, although Prevotella species have been reported to produce β-lactamase and be resistant to β-lactam antibiotics. The purpose of this study was to evaluate β-lactamase production and antimicrobial susceptibility to 12 β-lactam antibiotics of Prevotella speciesisolated from 128 orofacial odontogenic infections. We confirmed that only Prevotella species were β-lactamasepositive in most isolates. Overall, 43.7% of pigmented Prevotella and 34.8% of nonpigmented Prevotella were positive for β-lactamase. The β-lactamase-positive strains were resistant to most of theantibiotics tested. However, piperacillin/tazobactam, cefmetazole, and faropenem showed antimicrobialactivity against these strains. In conclusion, this study shows the importance of β-lactamase-producing Prevotella strains in odontogenic infections and the need for appropriate choice of antibiotic.

Incidence of beta-lactamase production and antimicrobial susceptibility of anaerobic gram-negative rods isolated from pus specimens of orofacial odontogenic infections.

The incidence of beta-lactamase production in anaerobic gram-negative rods isolated from 93 pus specimens of orofacial odontogenic infections and the antimicrobial susceptibility of these isolates against 11 antibiotics were determined. A total of 191 anaerobic gram-negative rods were isolated from the specimens. Beta-lactamase was detected in 35.6% of the black-pigmented Prevotella and 31.9% of the nonpigmented Prevotella. However, no strains among the other species isolated produced beta-lactamase. Ampicillin, cefazolin and cefotaxime showed decreased activity as regards beta-lactamase-positive Prevotella strains, whereas the activity of ampicillin/sulbactam, cefmetazole, and imipenem continued to be effective against such strains. All tested beta-lactam antibiotics were effective against Porphyromonas and Fusobacterium. Erythromycin showed decreased activity against nonpigmented Prevotella and Fusobacterium. Clindamycin, minocycline and metronidazole were powerful antibiotics against which anaerobic gram-negative rods could be tested. The present study showed that beta-lactamase-positive strains were found more frequently in the Prevotella strains than in any of the other species of anaerobic gram-negative rods. The effectiveness of adding sulbactam to ampicillin was demonstrated, as well as the difference in cephalosporin activity against beta-lactamase-positive strains.

Bacteriologic features and antimicrobial susceptibility in isolates from orofacial odontogenic infections.

The aim of this study was to obtain information for an effective antimicrobial therapy against orofacial odontogenic infections; such information was obtained from recent bacteriologic features and antimicrobial susceptibility data. The bacteriology and antimicrobial susceptibility of major pathogens in 163 patients with orofacial odontogenic infections to 7 antibiotics was examined. Mixed infection of strict anaerobes with facultative anaerobes (especially viridans streptococci) was observed most often in dentoalveolar infections, periodontitis, and pericoronitis. Penicillin (penicillin G) was effective against almost all pathogens, although it did not work well against beta-lactamase-positive Prevotella. Cefmetazole was effective against all test pathogens. Erythromycin was ineffective against viridans streptococci and most Fusobacterium. Clindamycin exerted a strong antimicrobial activity on anaerobes. Minocycline was effective against almost all the test pathogens. The antimicrobial activity of levofloxacin against viridans streptococci was not strong. An antibiotic that carries out antimicrobial activity against both viridans streptococci and oral anaerobes should be suitable for treatment of dentoalveolar infection, periodontitis, and pericoronitis. Penicillin remains effective as an antimicrobial against most major pathogens in orofacial odontogenic infections. Cefmetazole, clindamycin, and minocycline may be effective against most pathogens, including penicillin-unsusceptible bacteria.

Characterization of bacterial orofacial infections using a new murine model

We devised a new murine orofacial infection model using bacteria from odontogenic infection origins and characterized the experimental infections. In this model, bacteria were injected into the submandible of mice. Streptococcus constellatus and Peptostreptococcus micros produced a single abscess at the injection site and their abscess-forming and lethal abilities were low: the median abscess-forming dose (AF50) of S. constellatus and P. micros were 108.5–10.7and 1010.2–10.6cfu/mouse, and their median lethal dose (LD50) were >11 and 1010.6–11cfu/mouse, respectively. Prevotella oralis and Fusobacterium nucleatum produced multiple abscesses and their abscess-forming and lethal abilities were strong: AF50of P. oralis andF. nucleatum were 106.0–6.4and 107.0–8.7cfu/mouse, and their LD50were 107.0–7.7and 108.3–9.9cfu/mouse, respectively. LD50of P. intermedia andP. gingivalis were 109.4–>11and 108.9–9.1cfu/mouse, respectively. Prevotella intermedia and Porphyromonas gingivalis generated a necrotizing lesion, which progressed rapidly. We conclude that this murine model could reflect human orofacial odontogenic infections and is useful to investigate the pathogenicity of causative bacteria of such infections.

Surgical Management of Orofacial Infections

This overview of the surgical management of orofacial odontogenic infections is designed as a practical guide for the oral and maxillofacial surgeon. Fortunately, the incidence of serious odontogenic infections is decreasing. This decreased frequency, however, necessitates diligent study and mental preparation in advance of the emergent situations in which such cases present.

Past administration of beta-lactam antibiotics and increase in the emergence of beta-lactamase-producing bacteria in patients with orofacial odontogenic infections.

The purpose of this study was to determine the current status of beta-lactamase-producing bacteria in orofacial odontogenic infections. Microbiologic data regarding purulent exudate from 111 cases with orofacial odontogenic infections were analyzed in relation to the past administration of beta-lactams. beta-lactamase-producing bacteria were isolated more frequently from the beta-lactam-administered group (38.5%) than from the beta-lactam-nonadministered group (10.9%; P <.005), and they were isolated more frequently as the duration of administration increased. The predominant bacteria isolated included Prevotella (the most frequent isolate), viridans streptococci, Peptostreptococcus, and Fusobacterium, and 7.1% of total isolates produced beta-lactamase. Penicillin and cefazolin worked well with beta-lactamase-nonproducing Prevotella but were remarkably affected by beta-lactamase-producing Prevotella. Cefmetazole, sulbactam/cefoperazone, and imipenem worked well against both types of Prevotella. beta-lactams are still suitable for the first antimicrobial therapy in the treatment of these infections. However, because past beta-lactam administration increases the emergence of beta-lactamase-producing bacteria, beta-lactamase-stable antibiotics should be prescribed to patients with unresolved infections who have received beta-lactams.

Antibiotic prophylaxis in orthognathic surgery: A 1 -day versus 5-day regimen

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