title: Endodontic pathogens causing deep neck space infections: clinical impact of different sampling techniques and antibiotic susceptibility.
abstract: BACKGROUND
  The aims of the present study were to compare microbial populations in patients suffering from deep neck space abscesses caused by primary endodontic infections by sampling the infections with aspiration or swabbing techniques and to determine the susceptibility rates of the isolated bacteria to commonly used antibiotics.
  
  
  METHODS
  A total of 89 patients with deep neck space abscesses caused by primary endodontic infections requiring extraoral incision and drainage under general anesthesia were included. Either aspiration or swabbing was used to sample microbial pus specimens. The culture of the microbial specimens and susceptibility testing were performed following standard procedures.
  
  
  RESULTS
  A total of 142 strains were recovered from 76 patients. In 13 patients, no bacteria were found. The predominant bacteria observed were streptococci (36%), staphylococci (13%), Prevotella (8%), and Peptostreptococcus (6%). A statistically significant greater number of obligate anaerobes were found in the aspiration group. The majority of patients presented a mixed aerobic-anaerobic population of bacterial flora (62%). The antibiotic resistance rates for the predominant bacteria were 10% for penicillin G, 9% for amoxicillin, 0% for amoxicillin clavulanate, 24% for clindamycin, and 24% for erythromycin.
  
  
  CONCLUSIONS
  The results of our study indicated that a greater number of anaerobes were found when sampling using the aspiration technique. Penicillin G and aminopenicillins alone are not always sufficient for the treatment of severe deep neck space abscesses; beta-lactamase inhibitor combinations are more effective. Bacteria showed significant resistant rates to clindamycin. Thus, its single use in penicillin-allergic patients has to be carefully considered.
authors.affiliation: University Hospital for Cranio-Maxillofacial and Oral Surgery, Medical University Vienna, Vienna, Austria. wolfgang.poeschl@meduniwien.ac.at
authors.forename: Paul W
authors.initials: PW
authors.lastname: Poeschl
authors.forename: Valentina
authors.initials: V
authors.lastname: Crepaz
authors.forename: Guenter
authors.initials: G
authors.lastname: Russmueller
authors.forename: Rudolf
authors.initials: R
authors.lastname: Seemann
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Hirschl
authors.forename: Rolf
authors.initials: R
authors.lastname: Ewers
mesh_terms: D000038:Abscess / Q000209:etiology / Q000382:microbiology* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000302:isolation & purification; D002648:Child; D002981:Clindamycin / Q000494:pharmacology; D015169:Colony Count, Microbial; D003790:Dental Pulp Necrosis / Q000150:complications* / Q000382:microbiology*; D004322:Drainage; D004352:Drug Resistance, Microbial; D005260:Female; D005491:Focal Infection, Dental / Q000382:microbiology*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009333:Neck; D010406:Penicillins / Q000494:pharmacology; D011446:Prospective Studies; D013048:Specimen Handling / Q000379:methods*; D013492:Suppuration / Q000382:microbiology; D055815:Young Adult; D001618:beta-Lactamases / Q000494:pharmacology
chemical_list: D010406:Penicillins; D002981:Clindamycin; D001618:beta-Lactamases