title: Non-oral gram-negative facultative rods in chronic periodontitis microbiota.
abstract: OBJECTIVE
  The subgingival prevalence of gram-negative facultative rods not usually inhabiting or indigenous to the oral cavity (non-oral GNFR), as well as selected periodontal bacterial pathogens, were evaluated by culture in untreated and treated chronic periodontitis patients.
  
  
  METHODS
  Subgingival biofilm specimens from 102 untreated and 101 recently treated adults with chronic periodontitis in the Netherlands were plated onto MacConkey III and Dentaid selective media with air-5% CO2 incubation for isolation of non-oral GNFR, and onto enriched Oxoid blood agar with anaerobic incubation for recovery of selected periodontal bacterial pathogens. Suspected non-oral GNFR clinical isolates were identified to a species level with the VITEK 2 automated system.
  
  
  RESULTS
  A total of 87 (42.9%) out of 203 patients yielded subgingival non-oral GNFR. Patients recently treated with periodontal mechanical debridement therapy demonstrated a greater prevalence of non-oral GNFR (57.4% vs 28.4%, P < 0.0001), and a greater number of different non-oral GNFR species (23 vs 14 different species), than untreated patients. Sphingomonas paucimobilis was the most frequently isolated subgingival non-oral GNFR species. Several GNFR species normally found in animals and human zoonotic infections, and not previously detected in human subgingival biofilms, were recovered from some patients, including Bordetella bronchispetica, Pasteurella canis, Pasteurella pneumotropica and Neisseria zoodegmatis. Porphyromonas gingivalis and Tannerella forsythia were significantly associated with the presence of subgingival non-oral GNFR.
  
  
  CONCLUSIONS
  A surprisingly high proportion of Dutch chronic periodontitis patients yielded cultivable non-oral GNFR in periodontal pockets, particularly among those recently treated with periodontal mechanical debridement therapy. Since non-oral GNFR species may resist mechanical debridement from periodontal pockets, and are often not susceptible to many antibiotics frequently used in periodontal practice, their subgingival presence may complicate periodontal treatment in species-positive patients and increase risk of potentially dangerous GNFR infections developing at other body sites.
authors.affiliation: Department of Medical Microbiology, Medical School, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Center for Dentistry and Oral Hygiene, Dental School, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Arie J
authors.initials: AJ
authors.lastname: van Winkelhoff
authors.affiliation: Department of Medical Microbiology, Medical School, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Patrick
authors.initials: P
authors.lastname: Rurenga
authors.affiliation: Department of Medical Microbiology, Medical School, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Gepke J
authors.initials: GJ
authors.lastname: Wekema-Mulder
authors.affiliation: Department of Medical Microbiology, Medical School, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Zadrach M
authors.initials: ZM
authors.lastname: Singadji
authors.affiliation: Department of Periodontology and Oral Implantology, and Oral Microbiology Testing Service Laboratory, Temple University School of Dentistry, Philadelphia, PA 19140, USA; Department of Microbiology and Immunology, Temple University School of Medicine, Philadelphia, PA 19140, USA. Electronic address: trams@temple.edu.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Rams
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D018441:Biofilms; D055113:Chronic Periodontitis / Q000188:drug therapy / Q000382:microbiology* / Q000628:therapy; D003773:Dental Plaque / Q000382:microbiology; D005260:Female; D005881:Gingiva / Q000382:microbiology; D006092:Gram-Negative Facultatively Anaerobic Rods / Q000187:drug effects / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D064307:Microbiota; D008875:Middle Aged; D009055:Mouth / Q000382:microbiology; D057747:Periodontal Debridement / Q000379:methods; D010514:Periodontal Pocket / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Chronic periodontitis; Gram-negative facultatively anaerobic rods; Humans; Periodontal pocket