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Commensal Flora
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
The commensal flora in the oropharynx consists mainly of anaerobes and streptococci. Coliforms can be transient colonizers, mainly in hospitalized patients. The most common anaerobes are Actinomyces, Bacteroides, Prevotella, Fusobacterium, Corynebacterium, Veillonella, Rothia and Capnocytophaga. Other members of the commensal flora are streptococci, Gemella and Granulicatella, Neisseria spp. and Haemophilus spp. Infections with oropharyngeal flora are seen in periodontal diseases, endocarditis and aspiration pneumonia. Oropharyngeal flora associated with endocarditis are viridans streptococci, Haemophilus spp. and members belonging to the HACEK group. Periodontal infections, perioral abscesses, sinusitis and mastoiditis may involve predominantly P. melaninogenica, Fusobacterium spp. and Peptostreptococcus spp. Aspiration of saliva may result in necrotizing pneumonia, lung abscess and empyema. Streptococcus mutans plays a particularly important role in dental plaques and caries. Eikenella corrodens is an important pathogen in human bites.
Benzylpenicillin (Penicillin G)
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Alasdair M. Geddes, Ian M. Gould, Jason A. Roberts, Jason A. Trubiano, M. Lindsay Grayson
Eikenella corrodens, another HACEK organism, is a slowly growing aerobic Gram-negative rod that is a normal inhabitant of the human oral cavity. It most commonly causes pleuropulmonary infections in patients with underlaying malignancy. Rarely it can cause a pancreatic abscess. Pen G is the best treatment although a few strains may be Pen G resistant (Joshi et al., 1991; Stein et al., 1993).
Fight Bite
Published in Raymond Anakwe, Scott Middleton, Trauma Vivas for the FRCS (Tr & Orth), 2017
Raymond Anakwe , Scott Middleton
Fight bites invariably warrant operative management due to the potential to develop septic arthritis. I would administer tetanus prophylaxis if indicated and take swabs from the wound prior to starting broad-spectrum intravenous antibiotics in accordance with local microbiology guidelines (co-amoxiclav would be the antibiotic of choice in my unit). The infection is typically polymicrobial but the most common organism cultured from a fight bite is Staphylococcus aureus. Gram negative bacteria should also be covered with the antibiotics as Eikenella corrodens is often implicated in a fight bite. I would photograph the wound and cover with saline-soaked swabs and a non-adherent dressing.
The pathogenic microbial flora and its antibiotic susceptibility pattern in odontogenic infections
Published in Drug Metabolism Reviews, 2019
Paul Andrei Tent, Raluca Iulia Juncar, Florin Onisor, Simion Bran, Antonia Harangus, Mihai Juncar
All the disadvantages of using penicilllins were overcome for a time period by administration of clindamycin, which has a higher rate of absorption, an increased concentration in the bone, a broader spectrum of action extending to resistant anaerobic strains, and can also be administered to penicillin-allergic patients (Kirkwood 2003; Bascones Martinez et al. 2004; Poveda Roda et al. 2007; Warnke et al. 2008; Sato et al. 2009; Sánchez et al. 2011). Nevertheless, the current overwhelming increase in bacterial resistance to clindamycin is extremely worrying (Lewis et al. 1995; Gordon et al. 2002; Seppälä et al. 2003; Smith et al. 2004; Plum et al. 2018). The research results of some authors describe the fact that the highest overall resistance of microbial strains isolated from the site of suppuration is to clindamycin (11–56%) (Kuriyama et al. 2000; Poeschl et al. 2010; Sánchez et al. 2011; Zirk et al. 2016, Heim et al. 2017). Zirk et al. (2016) isolated Eikenella corrodens strains from head and neck infections 100% resistant to clindamycin. The ineffectiveness of clindamycin on the Eikenella corrodens species has been reported in other literature studies (Rodríguez-Avial et al. 2001; Bascones Martinez et al. 2004; Brescó-Salinas et al. 2006; Sánchez et al. 2011). However, contrary to this result, Liau et al. (2018) describe low rates (3.8%) of overall resistance to clindamycin.