Prevalence of subgingival bacteria resistant to aminopenicillins and metronidazole in dental patients from Yemen and Norway
Introduction
The oral flora is comprised of more than 600 cultivable and non-cultivable species [1]. In certain conditions and when the ecology of the oral microbiota is disturbed, a subset of these species become virulent and cause infections. Utilising antimicrobial agents is one way to fight such infections. However, like most medically significant bacteria, antimicrobial resistance among oral bacteria is an evolving problem. Several studies on susceptibility testing of oral bacteria reported the presence of isolates that were resistant to penicillin, metronidazole, tetracycline and macrolides [2]. Antimicrobial resistance is a global problem and one of the biggest challenges facing public health today [3]. The problem is complex and multifactorial [4], [5], [6] and also of increasing concern to dentistry [2], [7]. Development of antimicrobial resistance mechanisms by pathogenic microorganisms is their way to evade antimicrobials and thus survive [8].
Most studies that deal with the emergence of antimicrobial resistance of oral bacteria have been done in the western world. Little information is therefore available from developing countries. Yemen, like most developing countries, possesses socioeconomic and behavioural factors that promote bacterial resistance [9]. In Yemen, self-prescription by individuals and misuse due to healthcare provider-related factors are common practices [10]. Data from Yemen are sparse and the few published reports regarding bacterial resistance call for urgent need of national surveillance [11]. On the other hand, to the best of our knowledge there is only one report from Norway regarding antibiotic resistance of oral bacteria [12]. This study found that 68% of 25 patients with refractory marginal periodontitis harboured β-lactamase-producing bacteria.
Our aim was to assess the prevalence in a developing country (Yemen) and a developed country (Norway) of selected subgingival bacteria resistant to aminopenicillins and metronidazole, two antimicrobials commonly prescribed by dentists [13], [14], [15], [16], to determine whether the information in the literature regarding antimicrobial-resistant human medical bacteria in the two countries is also valid for oral bacteria.
Section snippets
Study subjects
Thirty-four Yemeni dental patients (mean age 30.1 ± 1.9 years) who visited three dental clinics in Sana’a, Yemen, during the summer of 2003, and 21 Norwegian dental patients (mean age 40.4 ± 2.3 years) who visited two clinics in Bergen, Norway, during the spring of 2004 were recruited for the study. All patients were in need of dental treatment and were selected consecutively among volunteers. Subjects were excluded from the study if they: (1) had general medical problems known to influence their
Prevalence of the probe species
All the probe species were detected in subgingival samples from both patient groups, but at different frequencies (Fig. 1). Porphyromonas gingivalis, Eubacterium nodatum, Streptococcus sanguinis and Veillonella parvula were significantly (P < 0.05) more prevalent in the Yemeni subjects, whilst Actinobacillus actinomycetemcomitans, Capnocytophaga gingivalis and Streptococcus mitis showed a significantly higher prevalence in the Norwegian samples.
Prevalence of resistant species
In the samples from the Yemeni subjects, 28.9% and
Discussion
Our aim was to assess the resistance to two commonly used antimicrobials (aminopenicillin and metronidazole) among 18 subgingival species in adults who visited a dental clinic in Yemen or Norway for various reasons. Most previous studies on antimicrobial resistance of oral bacteria referred to periodontitis patients [12], [24]. Few of the sample donors in our study suffered from periodontitis. By using paper points, subgingival planktonic bacteria and loosely attached dental biofilm, which
Acknowledgments
We would like to thank Dr Arhab Noman for his help during data collection. This study was supported by the Norwegian Loan Fund for Education.
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