Oral succession of gram-negative bacilli in myelosuppressed cancer patients

268

199

The subgingival occurrence of yeasts and species of Enterobacteriacae and Pseudomonas was studied in 500 adults with severe periodontitis. All subjects had sites non‐responding or “refractory” to conventional periodontal therapy. Most subjects had received one or more courses of broad‐spectrum systemic antibiotics. Subgingival microbial samples were collected with paper points and transported in VMGA III. The bacterial samples were plated on enriched brucella blood agar and incubated anaerobically, and on TSBV, TBC, and Sabouraud agar, which were incubated in 10% CO2. Yeasts were speciated using the API 20C micro‐method system and the germ tube test (for Candida albicans). Enteric organism's and pseudomonads were speciated with the API 20E kit system. Yeasts, enteric rods and pseudomonads were subjected to antibiotic susceptibility testing. The occurrence of Actinobacillus actinomycetemcomitans, Bacteroides gingivalis, and Bacteroides intermedium was also determined in the patients studied. In the 500 periodontitis patients, yeasts were detected in 84 (16.8%), enteric rods or pseudo‐monads in 51 (10.2%), and both yeasts and enterics or pseudomonads in 6 (1.2%). Candida albicans comprised 83.3% of the isolated yeasts. Enterobacteriaceae averaged 21–39% of the cultivable flora in culture‐positive cases, with Enterobacter cloacae, Enterobacter agglomerans, Proteus mirabilis, Klebsietta pneumonias, and Klebsiella oxytoca being the most frequent species. Pseudomonas aeruginosa was isolated from 10 patients, averaging 23.4% of the cultivable subgingival flora. All Candida isolates, and 86–95% of the enteric rods and pseudomonads, were resistant to 1 μg/ml of tetracycline, penicillin G, and erythromycin. In patients positive for yeasts, enteric rods or pseudomonads, A. actinomycetemcomitans was isolated from about one‐fifth, B. intermedius from about one‐third, and B. gingivalis from 5% of the individuals. The present findings suggest that yeasts or enteric rods or pseudomonads occur in the subgingival flora of about one‐third of “refractory” adult periodontitis patients. We caution against using antibiotics without prior microbiological screening in treating this patient group.

Section: Discussionmentioning

confidence: 95%

“…P. aeruginosa has been recovered from the subgingival flora of human subjects with early periodontal disease (64) and acute periodontal abscesses (51), but little evaluation has been made of pseudomonads in advanced periodontitis sites (42). F. aeruginosa has also recently been isolated from a "refractory" periapical lesion (6).…”

Section: Discussionmentioning

confidence: 99%

Yeasts, enteric rods and pseudomonads in the subgingival flora of severe adult periodontitis

Slots

Rams

Listgarten

1988

268

199

“…and Acittetobaeter are opportunistic pathogens in a wide range of human infections (3,12,27). These primarily non-oral bacteria may colonize the litiman oral cavity, especially in patients with debilitating systemic diseases (11), or those treated with extended systemic antimicrobial or cytotoxic medications (4, 5,14,19,24). Enteric rods and p.seudomonads have been recovered from the subgingival flora of advanced periodontitis lesions (10, 23) and have been implicated as key pathogens in some cases of "refractory"" periodontitis (10).…”

Section: Fnterobactcriaceae Pseudotnonadaceaementioning

confidence: 99%

Prevalence and antimicrobial susceptibility of Enterobacteriaceae, Pseudomonadaceae and Acinetobacter in human periodontitis

Slots

Feik

Rams

1990

140

This study examined the occurrence of non-oral gram-negative facultatively anaerobic rods in advanced adult periodontitis. Speciation and in vitro antimicrobial susceptibility testing was performed using the MicroScan micromethod system. A total of 42 taxa of Enterobacteriaceae, Pseudomonadaceae and Acinetobacter were isolated from 427 of 3,050 (14.0%) patients. In 159 (5.2%) patients, these organisms comprised more than 5% of the cultivable subgingival microflora. Enterobacter cloacae, Klebsiella pneumoniae, Pseudomonas aeruginosa, Klebsiella oxytoca and Enterobacter agglomerans accounted for more than 50% of all strains isolated. Virtually all study strains demonstrated high in vitro susceptibility to ciprofloxacin, but exhibited variable susceptibility patterns to 18 other antimicrobial agents tested. In 3 "refractory" periodontitis patients heavily infected with enteric rods, systemic ciprofloxacin therapy (500 mg BiD for 10 days) led to resolution of the subgingival infections and improved clinical periodontal status. The present findings indicate that 5% of severe periodontitis lesions may harbor high levels of non-oral, gram-negative, facultatively anaerobic rods. Systemic ciprofloxacin appears to be capable of eradicating these potential pathogens from deep periodontal pockets.

“…In immunocompromised individuals these microorganisms may occur in great numbers. The infections caused are referred to as opportunistic infections (1,10,14,31). Antibiotics may suppress the normal mucosal flora, allowing an increase of insusceptible microorganisms, causing a superinfection (7,9).…”

mentioning

confidence: 99%

Occurrence of enteric rods, staphylococci and Candida in subgingival samples

Dahlén

Wikström

1995

The frequency and percentage of enteric rods, staphylococci and Candida were determined in 973 subgingival samples collected from 535 patients subjected to different periodontal treatment procedures. The analysis was performed with culture technique using selective and nonselective media. One or more organisms were detected in 65.5% of the samples and in 76.7% of the patients. In most samples enteric rods, staphylococci and/or Candida constituted a small amount of the total microbial viable count. Enteric rods exceeded 10% of the total viable count in 30 samples. Staphylococci occurred in more than 10% in only 3 samples. In these 3 samples, enterics constituted more than 10% of the total viable count. Candida was not found to exceed 10% of the total viable count in any of the samples. No statistically significant correlation was found between the presence of any of the target microorganisms and kind of periodontal treatment procedure received, antibiotic administration or sample transport time.