Results of bacterial cultivation are infrequently utilized in the treatment of patients hospitalized with severe odontogenic infections - a retrospective cohort study

BACKGROUND: Patients hospitalized with severe odontogenic infections (SOI) receive empiric intravenous antibiotics. Microbiological cultivation and antibiotic susceptibility testing are commonly performed, although the clinical value is debated.

OBJECTIVE: To assess the value of routine microbiological cultivation and susceptibility testing in patients hospitalized with SOI.

DESIGN: This retrospective cohort study included patients hospitalized with SOI, at the University Hospital of Copenhagen, Denmark, from November 2012 to 2019. Data on microbiological cultivation, bacterial identification and antibiotic susceptibility testing were obtained from hospital records. Statistical analysis included χ² test, Fisher's exact test, analysis of variance and logistic regression.

RESULTS: A total of 384 patients were included, with microbiological data available for 243 patients. Antibiotic treatment was modified in 47 patients and in seven cases, the modification was based on cultivation and antibiotic susceptibility testing. Higher age was associated with the need for cultivation and susceptibility testing (p = 0.006). The infections were polymicrobial, predominantly involving resident oral microbiota. Streptococcus was the most frequent genus (34% of isolates). Penicillin resistance was observed in 30% of all isolates.

CONCLUSION: Testing rarely influences antibiotic management in SOI. Higher age showed limited predictive value. The high prevalence of penicillin resistance among patients with SOI warrants further investigation.