Antibiotic sensitivity in periodontally pathogenic bacteria isolated from patients with purulent inflammatory disorders of the periodontal tissues

Abstract

The treatment of purulent inflammatory diseases in the periodontal tissues (PIDP) is one of the pertinent problems of modern dentistry. Qualitative and quantitative changes in the normal microflora of the oral cavity and activation of the periodontogenic microflora are considered to be some of the main etiological factors of periodontal inflammation. This includes Aggregatibacter actinomycetemcomitans (according to the old nomenclature - Actinobacillus actinomycetemcomitans), Tannerella forsythia (Bacteroides forsythus), Porphyromonas gingivalis, Prevotella intermedia, Wollinella recta (Campylobacter rectus), Fusobacterium nucleatum, Treponema denticola, as well as Parvimonas micra (Peptostreptococcus micros). Both cultivation and identification of the anaerobic microorganisms are considerably labor consuming. In most cases, in the regular laboratory practice, the determination of sensitivity of anaerobic microorganisms to antibacterial agents is not carried out. Therefore, antibacterial therapy is prescribed empirically without considering the general knowledge of anaerobic organisms’ sensitivity to antibiotics. This promotes the appearance of antibiotic resistant strains among microorganisms. As efficacy of antimicrobial therapy remains the main problem in PIDP treatment, we have carried out the study of sensitivity of isolated periodontally pathogenic agents to antibacterial preparations. There were 245 patients studied in total, older than 20 years of age, diagnosed with acute and chronic periodontal diseases, hypertrophic pulpitis, granulating periodontitis, periodontopathy, and local periodontitis with a fistula. The clinical material was collected from gingival pockets adhering to aseptic rules before the start of antibiotic therapy. Determination of antibiotic sensitivity was carried out for the bacteria Porphyromonas spp., Prevotella spp. and Fusobacterium. Sensitivity of the isolated periodontally pathogenic microorganisms’ strains to antibacterial agents was determined according to the recommendations of the Institute of Clinical Laboratory Standards (CLSІ).
During the study of sensitivity of Porphyromonas spp. to metronidazole it was determined that all clinical isolates were sensitive to that antibacterial agent. Agents of the carbapenem group were also effective, including meropenem, imipenem and ertapenem (100 % sensitive strains). There were 84,6% strains sensitive to clindamycin, benzylpenicillin, ampicillin, amoxicillin, piperacillin. High activity was observed for amoxiclav – 100% sensitive strains. Relatively low quantity of strains has demonstrated sensitivity to tetracycline, doxycycline and levomycetin – 23% sensitive isolates. As for Prevotella spp., all strains were similarly sensitive to the carbapenem activity. Most of the bacteria have exhibited sensitivity to metronidazole (88,2%) and clindamycin (76,5 % sensitive strains). More than a half of Prevotella spp. strains were sensitive to amoxiclav and piperacillin (58,8 %). The least number of sensitive strains were observed for benzylpenicillin, ampicillin and amoxicillin - – 29,4 %. There were 4 isolates among Fusobacterium strains that were sensitive to metronidazole and carbapenems. Lately, sensitivity of anaerobic bacteria to antimicrobial agents has decreased considerably that is confirmed by multiple data in literature, therefor empirical prescription of antibiotics can have little efficacy. Anaerobic bacteria in PIDP are usually isolated in forms of various associations with aerobic microorganisms that considerably complicates antimicrobial therapy, and the selected agents must be equally effective towards all isolated pathogens, therefore search, development, and improvement of approaches and methods of PIDP treatment remain still pertinent today.
Keywords: inflammatory diseases in the periodontal tissues, parodontally pathogenic microorganisms, antibiotic sensitivity.

DOI: 10.5281/zenodo.6350387