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Retrospective analysis of bacterial colonization of necrotic bone and antibiotic resistance in 98 patients with medication-related osteonecrosis of the jaw (MRONJ)

OBJECTIVES: The aim of our study was to describe microbial flora associated with MRONJ and characterize the susceptibility of pathogens to help guide an effective empiric antibiotic treatment in these patients. MATERIALS AND METHODS: A retrospective, single-center analysis was performed, using 116 b...

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Autores principales: Ewald, Florian, Wuesthoff, Falk, Koehnke, Robert, Friedrich, Reinhard E., Gosau, Martin, Smeets, Ralf, Rohde, Holger, Assaf, Alexandre T.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8060223/
https://www.ncbi.nlm.nih.gov/pubmed/33006027
http://dx.doi.org/10.1007/s00784-020-03595-9
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author Ewald, Florian
Wuesthoff, Falk
Koehnke, Robert
Friedrich, Reinhard E.
Gosau, Martin
Smeets, Ralf
Rohde, Holger
Assaf, Alexandre T.
author_facet Ewald, Florian
Wuesthoff, Falk
Koehnke, Robert
Friedrich, Reinhard E.
Gosau, Martin
Smeets, Ralf
Rohde, Holger
Assaf, Alexandre T.
author_sort Ewald, Florian
collection PubMed
description OBJECTIVES: The aim of our study was to describe microbial flora associated with MRONJ and characterize the susceptibility of pathogens to help guide an effective empiric antibiotic treatment in these patients. MATERIALS AND METHODS: A retrospective, single-center analysis was performed, using 116 bone samples from 98 patients. The bone samples were homogenized and subjected to routine culture methods. Growing bacteria were differentiated to the species level using whole-cell mass spectrometry and subjected to susceptibility testing. RESULTS: A highly diverse microbial flora was detected in necrotic bone, with a simultaneous presence of two or more bacterial species in 79% of all patients. In at least 65% of samples, gram-negative isolates were detected. Therefore, bacterial species resistant against β-lactamase inhibitors were present in at least 70% of all patients. CONCLUSIONS: The empiric choice of antibiotics in MRONJ patients should consider the high rate of gram-negative bacteria and resistance against β-lactam antibiotics. CLINICAL RELEVANCE: According to recent guidelines and recommendations, systemic antibiotic treatment is a key component in the treatment of all stage 2 and 3 MRONJ patients. We recommend using fluoroquinolones for empiric treatment and emphasize the use of bacterial cultivation and susceptibility testing to enable an effective antibiotic treatment. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00784-020-03595-9) contains supplementary material, which is available to authorized users.
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spelling pubmed-80602232021-05-05 Retrospective analysis of bacterial colonization of necrotic bone and antibiotic resistance in 98 patients with medication-related osteonecrosis of the jaw (MRONJ) Ewald, Florian Wuesthoff, Falk Koehnke, Robert Friedrich, Reinhard E. Gosau, Martin Smeets, Ralf Rohde, Holger Assaf, Alexandre T. Clin Oral Investig Original Article OBJECTIVES: The aim of our study was to describe microbial flora associated with MRONJ and characterize the susceptibility of pathogens to help guide an effective empiric antibiotic treatment in these patients. MATERIALS AND METHODS: A retrospective, single-center analysis was performed, using 116 bone samples from 98 patients. The bone samples were homogenized and subjected to routine culture methods. Growing bacteria were differentiated to the species level using whole-cell mass spectrometry and subjected to susceptibility testing. RESULTS: A highly diverse microbial flora was detected in necrotic bone, with a simultaneous presence of two or more bacterial species in 79% of all patients. In at least 65% of samples, gram-negative isolates were detected. Therefore, bacterial species resistant against β-lactamase inhibitors were present in at least 70% of all patients. CONCLUSIONS: The empiric choice of antibiotics in MRONJ patients should consider the high rate of gram-negative bacteria and resistance against β-lactam antibiotics. CLINICAL RELEVANCE: According to recent guidelines and recommendations, systemic antibiotic treatment is a key component in the treatment of all stage 2 and 3 MRONJ patients. We recommend using fluoroquinolones for empiric treatment and emphasize the use of bacterial cultivation and susceptibility testing to enable an effective antibiotic treatment. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00784-020-03595-9) contains supplementary material, which is available to authorized users. Springer Berlin Heidelberg 2020-10-02 2021 /pmc/articles/PMC8060223/ /pubmed/33006027 http://dx.doi.org/10.1007/s00784-020-03595-9 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article
Ewald, Florian
Wuesthoff, Falk
Koehnke, Robert
Friedrich, Reinhard E.
Gosau, Martin
Smeets, Ralf
Rohde, Holger
Assaf, Alexandre T.
Retrospective analysis of bacterial colonization of necrotic bone and antibiotic resistance in 98 patients with medication-related osteonecrosis of the jaw (MRONJ)
title Retrospective analysis of bacterial colonization of necrotic bone and antibiotic resistance in 98 patients with medication-related osteonecrosis of the jaw (MRONJ)
title_full Retrospective analysis of bacterial colonization of necrotic bone and antibiotic resistance in 98 patients with medication-related osteonecrosis of the jaw (MRONJ)
title_fullStr Retrospective analysis of bacterial colonization of necrotic bone and antibiotic resistance in 98 patients with medication-related osteonecrosis of the jaw (MRONJ)
title_full_unstemmed Retrospective analysis of bacterial colonization of necrotic bone and antibiotic resistance in 98 patients with medication-related osteonecrosis of the jaw (MRONJ)
title_short Retrospective analysis of bacterial colonization of necrotic bone and antibiotic resistance in 98 patients with medication-related osteonecrosis of the jaw (MRONJ)
title_sort retrospective analysis of bacterial colonization of necrotic bone and antibiotic resistance in 98 patients with medication-related osteonecrosis of the jaw (mronj)
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8060223/
https://www.ncbi.nlm.nih.gov/pubmed/33006027
http://dx.doi.org/10.1007/s00784-020-03595-9
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