Bacteriology of Dentoalveolar Abscesses in Patients Who Have Received Empirical Antibiotic Therapy

Abstract

We investigated aspirates of pus from dentoalveolar abscesses in 13 patients who had received empirical antibiotic therapy within 1 month before presentation at our facility. The antibiotics administered were lincomycin, amoxicillin, ampicillin, or a cephalosporin. Information on antibiotic therapy was obtained from the patients' medical histories. Cultures of all dentoalveolar abscesses yielded organisms. A total of 70 isolates (42 anaerobes and 28 facultative organisms) were recovered, representing 5.3 isolates (3.2 anaerobes and 2.1 facultative organisms) per specimen. The counts of bacteria ranged from 5 X 10(7) cfu/mL to 8 X 10(11) cfu/mL (mean count, 1.4 X 10(11) cfu/mL; median count, 2.3 X 10(10) cfu/mL). The predominant isolates were Prevotella species (25.7% of isolates), Peptostreptococcus species (17.1%), and Streptococcus species (14.2%). This study illustrates the polymicrobial nature of dentoalveolar abscesses as well as the predominant role played by anaerobic bacteria.

Microbiology and Treatment of Acute Apical Abscesses

“…However, some important limitations of culture make it difficult to achieve a comprehensive analysis of the apical abscess microbiota. Because anaerobic bacteria are dominant in apical abscesses (40)(41)(42)(43)(44)(45)(46)(47)(48)(49), samples for research or clinical diagnosis using culture should be collected and transported to the laboratory under conditions that favor the survival of these bacteria. The laboratory that will analyze the samples has to be properly prepared and equipped to isolate, cultivate, and identify anaerobes.…”

“…The first generation involves studies of the abscess microbiota conducted using open-ended (or broad-range) culture methods, which disclosed many cultivable species in association with the disease (41)(42)(43)(44)(45)(46)(47)(48)(49). The second generation consisted of studies employing closed-ended molecular detection methods, such as species-specific PCR and its derivatives as well as the original checkerboard hybridization assay, to target cultivable bacteria (74)(75)(76)(77)(78)(79)(80)(81)(82).…”

“…Dark-pigmented anaerobic bacteria have been closely associated with acute symptoms of endodontic infections, including abscesses (41,47,(96)(97)(98)(99)(100). Two culture studies (42,101) found that virtually all abscesses of endodontic origin harbored one or more species of this group.…”

The microbiology of the acute dental abscess

“…In mixed infections, strict anaerobes outnumber facultatives by a ratio which varies between 1.5-3 : 1, again depending on the recovery and culture conditions Khemaleelakul et al, 2002;Kulekci et al, 1996;Lewis et al, 1993;Roche & Yoshimori, 1997;Sakamoto et al, 1998). The mean number of species recovered by culture from dentoalveolar aspirates is 4 with a range of between 1 and 7.5 (Fazakerley et al, 1993;Khemaleelakul et al, 2002;Reader et al, 1994).…”

“…However, a number of more recent studies have indicated that staphylococci may indeed be a more frequent colonizer of the oral tissues than previously thought (Smith et al, 2001). The recovery rates using conventional culture of Staphylococcus aureus from the acute dental abscess range from 0.7 to 15 % (Brook et al, 1991;Goumas et al, 1997;Kulekci et al, 1996;Kuriyama et al, 2002b;Roche & Yoshimori, 1997;Siqueira et al, 2001d) although some workers have noted higher recovery rates of 47 % (Mangundjaja & Hardjawinata, 1990). Interestingly, Staphylococcus aureus has been reported to occur more frequently in severe dental abscesses from children (Brook et al, 1991;Coticchia et al, 2004;Coulthard & Isaacs, 1991;Dodson et al, 1989;Tan et al, 2001).…”