Microbial Composition and Pattern of Antibiotic Resistance in Subgingival Microbial Samples From Patients With Refractory Periodontitis

Abstract

A series of 993 subgingival microbial samples sent to a diagnostic microbiology laboratory included 196 samples that could be identified as compatible with a clinical diagnosis of refractory or recurrent periodontitis. In descending order of prevalence the associated microbiota included Bacteroides forsythus (84%), spirochetes (83%), motile rods (76%), Fusobacterium species (68%), Porphyromonas gingivalis (63%), Campylobacter rectus (47%), Capnocytophaga species (38%), Prevotella intermedia (23%), Peptostreptococcus micros (18%), Actinobacillus actinomycetemcomitans (16%), Candida (14%), enteric rods (9%), Staphylococcus species, not including aureus (5.6%). Eikenella corrodens (3%), Staphylococcus aureus (1.5%), and Enterococcus species (< 1%). Antibiotic resistance to tetracycline, penicillin G, or metronidazole was particularly noticeable for enteric rods, Fusobacterium species, Capnocytophaga species, Staphylococcus, and Actinobacillus actinomycetemcomitans. It was largely absent for Campylobacter rectus. No antibiotic sensitivity data were obtained for Porphyromonas gingivalis or Bacteroides forsythus, as these species were detected by immunofluorescence. The results indicate that a substantial number of microorganisms associated with refractory periodontitis are variably resistant to commonly-used antibiotics. Diagnostic microbiology must be considered an essential adjunct to the therapist faced with periodontal lesions refractory to conventional treatment.

The Antimicrobial Treatment of Periodontal Disease: Changing the Treatment Paradigm

“…In a clinical trial involving azithromycin, A. actinomycetemcomitans was found in six of 46 subjects, P. gingivalis was present in nine of 44, P. intermedia in 21 of 44, any black-pigmented anaerobes in 39 of 44, and spirochetes in 40 of 44 subjects (Sefton et al, 1996). A. actinomycetemcomitans could be detected in 16% of 196 subgingival plaque samples removed from sites of refractory or recurrent periodontitis, whereas B. forsythus was detected in 84% of the samples, spirochetes in 83%, Fusobacterium species in 68%, and P. gingivalis in 63% (Listgarten et al, 1993). Umeda et al (1996) examined plaques removed from pockets showing clinical symptoms of pain and suppuration and found spirochetes to account for 27% of the microscopic count, and P. gingivalis and B. forsythus to account for 26% and 11%, respectively, of the cultivable count.…”

Role of Treponema Denticola in Periodontal Diseases

“…Especially noteworthy is an enzyme-linked immunosorbent assay procedure, developed with a monoclonal antibody specific for a serovariety of T. denticola (Simonson et al, 1988 (Listgarten et al, 1993). In descending order of prevalence, the associated microbiota included: B. forsythus (84%), spirochetes (83%), motile rods (76°o), Fusobacterium species (68%), and P. gingivalis (63%).…”

Diagnóstico y tratamiento de la periodontitis agresiva

“…Some reports support the existence of subgingival microbiota resistant to antibiotics of choice (33)(34)(35)(36)(37)(38)(39)(40) , which could explain eventual failures in the therapeutic modality. Localized aggressive periodontitis is mainly associated with the bacteria Aggregatibacter actinomycetemcomitans (41,42) , while generalized aggressive periodontitis is strongly associated with specific bacteria such as Porphyromonas gingivalis, Tannerella forsythia (43,44) and Aggregatibacter actinomycetemcomitans, Gram-negative coccobacillus, capnophile, microaerophilic (45) .…”