Resistance profiles to antimicrobial agents in bacteria isolated from acute endodontic infections: systematic review and meta-analysis

Abstract

Infected root canal or acute apical abscess exudates can harbour several species, including Fusobacterium, Porphyromonas, Prevotella, Parvimonas, Streptococcus, Treponema, Olsenella and not-yet cultivable species. A systematic review and meta-analysis was performed to assess resistance rates to antimicrobial agents in clinical studies that isolated bacteria from acute endodontic infections. Electronic databases and the grey literature were searched up to May 2015. Clinical studies in humans evaluating the antimicrobial resistance of primary acute endodontic infection isolates were included. PRISMA guidelines were followed. A random-effect meta-analysis was employed. The outcome was described as the pooled resistance rates for each antimicrobial agent. Heterogeneity and sensitivity analyses were performed. Subgroup analyses were conducted based upon report or not of the use of antibiotics prior to sampling as an exclusion factor (subgroups A and B, respectively). Data from seven studies were extracted. Resistance rates for 15 different antimicrobial agents were evaluated (range, 3.5-40.0%). Lower resistance rates were observed for amoxicillin/clavulanic acid and amoxicillin; higher resistance rates were detected for tetracycline. Resistance rates varied according to previous use of an antimicrobial agent as demonstrated by the subgroup analyses. Heterogeneity was observed for the resistance profiles of penicillin G in subgroup A and for amoxicillin, clindamycin, metronidazole and tetracycline in subgroup B. Sensitivity analyses demonstrated that resistance rates changed for metronidazole, clindamycin, tetracycline and amoxicillin. These findings suggest that clinical isolates had low resistance to β-lactams. Further well-designed studies are needed to clarify whether the differences in susceptibility among the antimicrobial agents may influence clinical responses to treatment.

Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling

“…To inform the current status of antibiotic prescribing behaviors of dentists, including antibiotic types, doses, and durations, we used a 2018 scoping review. 24 We also included input from stakeholders and expert panelists and data on antibiotic sensitivity [54][55][56][57][58] to determine the most appropriate course of action when first-line treatment fails, guidance to avoid recommending antibiotics closely monitor their symptoms and call a dentist or primary care provider if their infection worsens while receiving therapy. Similarly, clindamycin has a US Food and Drug Administration black box warning for Clostridioides difficile infection, which can be fatal.…”

Microbial ecology and predicted metabolic pathways in various oral environments from patients with acute endodontic infections

“…The reasons for their existence inside the root canal would be the presence of sufficient moisture or a water-saturated medium through which they can propel themselves to such distances into the canal, and presence of nutrients to allow them to migrate and survive 'technically' beyond the viable part of the body. Moreover, data from a meta-analysis conducted by Lang et al (2016) suggested a change in resistance patterns of strains isolated from acute endodontic infections in samples of patients who had taken antimicrobial agents before collection. Therefore, the dynamic nature of host/microbial interaction at the apical region and the ecology of the infected pulp cavity should be revisited.…”

Detection of Genes Related to Resistance to Silver Nanoparticles in Bacteria from Secondary Endodontic Infections

“…After a review of the literature, as far as we know, there are no studies in the endodontic literature in which the presence of resistance genes is correlated with the different clinical symptoms of resistant infections (secondary endodontic infection). Many studies have only focused on detecting the presence of resistance genes in different oral environments, including bacteria isolated from different types of endodontic infections [35,36]. Other studies have only been dedicated to associate the presence of certain bacterial species with the presence of clinical symptoms [37].…”