Antibiotic resistance in severe odontogenic infections of the South Australian population: a 9‐year retrospective audit

Liau, I.; Han, Jennie; Bayetto, K.; May, Barnaby C. H.; Goss, AN; Sambrook, Paul; Cheng, A.

doi:10.1111/adj.12607

Cited by 30 publications

(55 citation statements)

References 17 publications

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“…Dental and medical practitioners must be aware that the primary treatment of odontogenic infection is prompt removal of the infective process, such as via dental extraction or endodontic debridement. The average cost of a single dental extraction in Australia at the conclusion of the study period was $181 Australian Dollars . This is a stark contrast to the financial sequelae of inpatient hospital admission reported in this study.…”

Section: Discussioncontrasting

confidence: 75%

“…The average cost of a single dental extraction in Australia at the conclusion of the study period was $181 Australian Dollars. 10 This is a stark contrast to the financial sequelae of inpatient hospital admission reported in this study. Antibiotic treatment is an adjunctive treatment and should not replace expedient dental care for the patient presenting with acute dental infection.…”

Section: Discussioncontrasting

confidence: 63%

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The financial burden of acute odontogenic infections: the South Australian experience

Han

Liau

Bayetto

et al. 2019

Australian Dental Journal

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Background Acute odontogenic infections are a common surgical emergency managed by public hospitals in Australia which cause considerable patient morbidity and occasionally, mortality. Despite posing a significant public health burden, Australian data evaluating the cost of the management of these patients are lacking. This study assessed the patient and treatment variables associated with inpatient management of deep odontogenic infections, and their respective financial impact, at a statewide Oral & Maxillofacial service. Methods A retrospective audit was carried out of patients with deep odontogenic infections at our institution, over a 7‐year period. The primary outcome was the total cost of admission. Secondary outcomes included treatment received, operating room time, return‐to‐theatre, length of admission (LOS), and intensive care unit (ICU) use. Cost variables were assessed against the total LOS and ICU use to determine clinical predictors affecting outcome. Results Four hundred and sixty two patients met the inclusion criteria. The average cost per patient was $12 228 Australian Dollars. After multivariate analysis, variables most significantly associated with increased cost of care and LOS were high‐risk infections with airway compromise, high admission white cell count and age. Conclusion Hospital‐based management of deep‐space odontogenic infections engender significant costs compared to early primary care intervention such as a dental extraction ($181/extraction).

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Section: Discussioncontrasting

confidence: 75%

Section: Discussioncontrasting

confidence: 63%

The financial burden of acute odontogenic infections: the South Australian experience

Han

Liau

Bayetto

et al. 2019

Australian Dental Journal

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“…Antibiotic resistance and stewardship have been given inadequate attention in the dental industry until recently . A retrospective audit of antibiotic resistance in severe odontogenic infections in the South Australian population showed that the rate of overall antibiotic resistance was 17.8%, with the most resistance to penicillin and amoxicillin . These patients consequently had longer hospital stays and a higher incidence of non‐response to initial surgical therapy .…”

Section: Introductionmentioning

confidence: 99%

“…5 A retrospective audit of antibiotic resistance in severe odontogenic infections in the South Australian population showed that the rate of overall antibiotic resistance was 17.8%, with the most resistance to penicillin and amoxicillin. 16 These patients consequently had longer hospital stays and a higher incidence of non-response to initial surgical therapy. 16 Other studies have parallel findings and have shown that bacteria which are common isolates from odontogenic infections have proven to have a frequency of penicillin resistance around 5%-20%.…”

Section: Introductionmentioning

confidence: 99%

“…16 These patients consequently had longer hospital stays and a higher incidence of non-response to initial surgical therapy. 16 Other studies have parallel findings and have shown that bacteria which are common isolates from odontogenic infections have proven to have a frequency of penicillin resistance around 5%-20%. 17,18 While it is established that dental practitioners in Australia make some inappropriate prescription choices, 11,12 to date, no study has investigated the factors that influence clinicians' prescribing habits.…”

Section: Introductionmentioning

confidence: 99%

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Perceptions, attitudes and factors that influence prescribing by general dentists in Australia: A qualitative study

Teoh

Stewart

Mariño

et al. 2019

J Oral Pathology Medicine

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Background Longitudinal studies of dental prescribing in Australia show that dentists make some inappropriate prescribing choices; literature has shown that dentists tend to overprescribe antibiotics and prescribe for incorrect indications. The unnecessary use of antibiotics is a contributing factor towards the development of antibiotic resistance. The aims of the study were to obtain a greater understanding of the perceptions, attitudes and factors that influence dental prescribing for all major relevant drug classes. Method Semi‐structured interviews of 15 purposively sampled dentists practising in Victoria, Australia were conducted from June–September 2018. Two dentists practised in rural areas and the remainder in urban locations. The range of clinical experience varied from 2.5 to 37 years, with a mean of 13 years. The transcripts were analysed thematically. Results Dentists generally preferred amoxicillin as first‐line therapy for odontogenic infections, with some confusion about the spectrum and uses of antibiotics. Overprescribing was evident, mostly due to basing judgement for use of antibiotics on symptoms rather than clinical signs. Other factors, such as time pressure, patient expectations, pressure from assistant staff, concern about online criticism and medico‐legal considerations, influenced prescribing. Of the dentists who prescribed anxiolytics, most did not have a care protocol for their sedated patients. Conclusion A variety of prescribing practices were described, and future interventions should target misconceptions around the appropriate use and choice of antibiotics, resources to address the shortfall in knowledge of therapeutics, patient education and staff training, as well as appropriate care and monitoring of sedated patients.

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Deep neck space infections: an upward trend and changing characteristics

Velhonoja

Lääveri

Soukka

et al. 2019

Eur Arch Otorhinolaryngol

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Purpose This study reviews our experience with deep neck space infections (DNIs) requiring surgical intervention, including cervical necrotizing fasciitis. The aim of the study was to identify predisposing and aggravating factors of the disease and recognize the possible factors that can lead to life-threatening complications and slow down the healing process. Methods We compare the results to previous data from 1985 to 2005 to find possible alterations and changing trends. The characteristics of four lethal cases are described. This retrospective analysis includes patient data from 2004 to 2015 in tertiary referral hospital and in total, 277 patients were found. Results Surgical drainage through a neck opening ± intraoral incision was made in 215 (77.6%) patients, an intraoral incision was only made in 62 patients (22.4%). ICU care was needed in 66 (23.8%) cases. Odontogenic etiology (44.8%) was the most common origin. The most common comorbidity was a psychiatric disorder and/or dementia and occurred in 55 (19.9%) patients. Patients with underlying illnesses were more likely to be admitted to the ICU (p = 0.020), required a longer ICU stay (p = 0.004) and repeated surgery (p = 0.009). Gas formation seemed to be predictive of a more severe course of infection. Early extraction of the odontogenic foci was related to a lower length of stay (LOS) (p = 0.039). Conclusion The annual numbers have risen from 14 to 24 cases per year when compared to previous data. DNIs remain a cause of lethal complications; the mortality was 1.4% and overall complications occurred in 61 (22.0%) patients.

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Antibiotic resistance in severe odontogenic infections of the South Australian population: a 9‐year retrospective audit

Cited by 30 publications

References 17 publications

The financial burden of acute odontogenic infections: the South Australian experience

The financial burden of acute odontogenic infections: the South Australian experience

Perceptions, attitudes and factors that influence prescribing by general dentists in Australia: A qualitative study

Deep neck space infections: an upward trend and changing characteristics

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