title: Resistance profiles to antimicrobial agents in bacteria isolated from acute endodontic infections: systematic review and meta-analysis.
abstract: Infected root canal or acute apical abscess exudates can harbour several species, including Fusobacterium, Porphyromonas, Prevotella, Parvimonas, Streptococcus, Treponema, Olsenella and not-yet cultivable species. A systematic review and meta-analysis was performed to assess resistance rates to antimicrobial agents in clinical studies that isolated bacteria from acute endodontic infections. Electronic databases and the grey literature were searched up to May 2015. Clinical studies in humans evaluating the antimicrobial resistance of primary acute endodontic infection isolates were included. PRISMA guidelines were followed. A random-effect meta-analysis was employed. The outcome was described as the pooled resistance rates for each antimicrobial agent. Heterogeneity and sensitivity analyses were performed. Subgroup analyses were conducted based upon report or not of the use of antibiotics prior to sampling as an exclusion factor (subgroups A and B, respectively). Data from seven studies were extracted. Resistance rates for 15 different antimicrobial agents were evaluated (range, 3.5-40.0%). Lower resistance rates were observed for amoxicillin/clavulanic acid and amoxicillin; higher resistance rates were detected for tetracycline. Resistance rates varied according to previous use of an antimicrobial agent as demonstrated by the subgroup analyses. Heterogeneity was observed for the resistance profiles of penicillin G in subgroup A and for amoxicillin, clindamycin, metronidazole and tetracycline in subgroup B. Sensitivity analyses demonstrated that resistance rates changed for metronidazole, clindamycin, tetracycline and amoxicillin. These findings suggest that clinical isolates had low resistance to β-lactams. Further well-designed studies are needed to clarify whether the differences in susceptibility among the antimicrobial agents may influence clinical responses to treatment.
authors.affiliation: Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
authors.forename: Pauline M
authors.initials: PM
authors.lastname: Lang
authors.affiliation: Endodontic Division, Department of Restorative Dentistry, Univ. Estadual Paulista, Araçatuba, SP, Brazil.
authors.forename: Rogério C
authors.initials: RC
authors.lastname: Jacinto
authors.affiliation: Post-Graduation Program in Epidemiology, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Tatiane S
authors.initials: TS
authors.lastname: Dal Pizzol
authors.affiliation: Department of Pharmacology, Institute of Health Basic Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
authors.forename: Maria Beatriz C
authors.initials: MB
authors.lastname: Ferreira
authors.affiliation: Endodontic Division, Department of Conservative Dentistry, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2492 Bairro Santana, 90035-003 Porto Alegre, RS, Brazil. Electronic address: francisco.montagner@ufrgs.br.
authors.forename: Francisco
authors.initials: F
authors.lastname: Montagner
mesh_terms: D000890:Anti-Infective Agents / Q000494:pharmacology*; D001419:Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D024881:Drug Resistance, Bacterial; D006801:Humans; D008826:Microbial Sensitivity Tests; D011671:Pulpitis / Q000382:microbiology*
chemical_list: D000890:Anti-Infective Agents
keywords: Acute endodontic infection; Antimicrobial agent; Meta-analysis; Periapical abscess; Susceptibility