Osteomyelitis of the jaw: resistance to clindamycin in patients with prior antibiotics exposure.
The purpose of this paper was to review our clinical experience in patients with osteomyelitis (OM) of the jaw, focusing on aspects of antimicrobial resistance. A retrospective review of the medical records of adult patients with jaw OM was carried out. Among 46 cases of jaw OM, the cause was odontogenic in 32 (seven had recent dental implants and four bisphosphonate osteonecrosis), postoperative/post-traumatic in eight, and secondary to osteoradionecrosis in six. Clinical features were chronic in 91.3%. The infection was polymicrobial in 24/41 (65.9%). Viridans streptococci were the most commonly isolated agents. Among 26 viridans streptococci tested, 81% were susceptible to penicillin and 96% to fluorquinolones, but only 11.5% to clindamycin. Overall, 35/38 (92.1%) had at least one clindamycin-resistant isolate. Appropriate antibiotics were administered for a mean of 5.8 +/- 3.2 months. Beta-lactams were used in 19 cases and fluorquinolones in 14. Among 39 cases with long-term follow-up, only two relapsed. Currently, jaw OM is commonly related to osteoradionecrosis, dental implants, and bisphosphonates. In patients with prior antibiotics exposure, a high percentage of infections were caused by clindamycin-resistant microorganisms, thus, beta-lactams should be the antibiotic of choice. In penicillin-allergic cases, the new fluorquinolones, probably in combination with rifampin and/or clindamycin, could be a promising alternative.
Pigrau
C
C
Hospital Universitari Vall D'Hebron, Universitat Autonoma, Barcelona, Spain. cpigrau@vhebron.net
Almirante
B
B
Rodriguez
D
D
Larrosa
N
N
Bescos
S
S
Raspall
G
G
Pahissa
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D002981:Clindamycin / Q000494:pharmacology* / Q000627:therapeutic use; D015921:Dental Implants / Q000382:microbiology; D004164:Diphosphonates; D024881:Drug Resistance, Bacterial / Q000187:drug effects; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000382:microbiology; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D007571:Jaw Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D010020:Osteonecrosis / Q000382:microbiology; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D013290:Streptococcal Infections / Q000188:drug therapy / Q000382:microbiology; D034363:Viridans Streptococci / Q000187:drug effects
D000900:Anti-Bacterial Agents; D015921:Dental Implants; D004164:Diphosphonates; D002981:Clindamycin
J Antimicrob Chemother. 2005 Oct;56(4):780-2
16120627
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005 Sep;100(3):263-4
16122650
Cochrane Database Syst Rev. 2003;(3):CD004152
12918006
J Bone Joint Surg Am. 2000 Feb;82(2):161-73
10682725
Infect Dis Clin North Am. 2007 Jun;21(2):543-56, viii
17561082
J Oral Maxillofac Surg. 1993 Dec;51(12):1294-301
8229407
Oral Surg Oral Med Oral Pathol. 1986 Jan;61(1):29-31
3456137
J Craniomaxillofac Surg. 1998 Feb;26(1):63-7
9563597
Clin Infect Dis. 2001 Oct 1;33(7):947-53
11528564
Cancer. 2005 Jul 1;104(1):83-93
15929121
Clin Infect Dis. 1997 Sep;25 Suppl 2:S194-8
9310676
Enferm Infecc Microbiol Clin. 1997 Jun-Jul;15(6):289-98
9376399
Oral Maxillofac Surg Clin North Am. 2003 Feb;15(1):155-60
18088670
Oral Microbiol Immunol. 2001 Feb;16(1):10-5
11169133
Clin Orthop Relat Res. 2003 Sep;(414):7-24
12966271
Antimicrob Agents Chemother. 2002 Dec;46(12):4019-21
12435716
Implant Dent. 2004 Dec;13(4):373-85
15592000
Int J Antimicrob Agents. 2001 Mar;17(3):195-201
11282264
J Oral Maxillofac Surg. 2003 Sep;61(9):1115-7
12966493
J Antimicrob Chemother. 2001 Oct;48(4):592-4
11581247
J Oral Maxillofac Surg. 2005 Nov;63(11):1567-75
16243172
Int J Oral Maxillofac Implants. 2003 May-Jun;18(3):383-90
12814313
Neuroimaging Clin N Am. 2003 Aug;13(3):605-18
14631694
Br J Oral Maxillofac Surg. 1985 Feb;23(1):24-35
3156622
Arch Otolaryngol Head Neck Surg. 1988 Oct;114(10):1157-62
3415825
Int J Oral Maxillofac Implants. 2003 Jul-Aug;18(4):561-5
12939009
J Antimicrob Chemother. 2000 May;45(5):605-9
10797081
Clin Infect Dis. 1995 Dec;21(6):1378-85
8749619
Gen Dent. 2008 Jan-Feb;56(1):20-8
18254556
Antimicrob Agents Chemother. 2001 Nov;45(11):3253-5
11600394
J Prosthet Dent. 2003 Aug;90(2):121-32
12886205
Antimicrob Agents Chemother. 1996 Apr;40(4):891-4
8849246
J Antimicrob Chemother. 1993 Jun;31 Suppl E:119-27
8396083
Oral Maxillofac Surg Clin North Am. 2003 Feb;15(1):129-38
18088667
Int J Antimicrob Agents. 2007 Apr;29(4):478-80
17296288
Oral Microbiol Immunol. 2004 Oct;19(5):331-5
15327647
Oral Maxillofac Surg Clin North Am. 2003 Feb;15(1):17-38
18088657
Clin Orthop Relat Res. 2003 Sep;(414):95-100
12966282
J Antimicrob Chemother. 2005 Dec;56(6):1063-8
16234335
Oral Microbiol Immunol. 2005 Feb;20(1):35-8
15612943
Int J Antimicrob Agents. 2002 Dec;20(6):451-6
12458140
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004 Oct;98(4):398-408
15472653