Periodontology Unit, UCL Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD, UK.
Microbiology Unit, Eastman Dental Hospital, UCLH NHS Foundation Trust, 256 Gray's Inn Road, London WC1X 8LD, UK; Department of Microbial Diseases, University College London, Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD, UK.
J Glob Antimicrob Resist. 2017 Sep;10:54-58. doi: 10.1016/j.jgar.2017.03.011. Epub 2017 Jun 28.
Aggregatibacter actinomycetemcomitans is a recognised pathogen involved in aggressive periodontitis. Seven serotypes of A. actinomycetemcomitans exist with a range of virulence and distribution dependent on ethnicity and geography. The ability of A. actinomycetemcomitans to invade soft tissue can necessitate the use of systemic antibiotics for treatment, however variations in its antibiotic susceptibility exist dependent on geographical location.
Serotypes of A. actinomycetemcomitans isolates from a UK cohort of 50 patients with aggressive periodontitis were determined by PCR. Resistance of the isolates to eight antibiotics [penicillin (1U), amoxicillin (2μg), amoxicillin/clavulanic acid (30μg), metronidazole (5μg), clindamycin (2μg), tetracycline (10μg), ciprofloxacin (5μg) and ceftazidime (30μg)] were determined by disk diffusion according to BSAC guidelines.
Prevalences of serotypes a, c, b, e and mixed serotypes were 48%, 22%, 2%, 2% and 12%, respectively. The serotype of isolates from seven patients (14%) could not be deduced by PCR. Of the 56 isolates tested, 100% were resistant to penicillin and metronidazole, 87.5% to clindamycin, 83.9% to amoxicillin and 76.8% to ceftazidime. Low rates of resistance to tetracycline (8.9% resistant) and amoxicillin/clavulanic acid (14.3% resistant) were observed, whereas no isolates were resistant to ciprofloxacin.
As in a number of publications the suggested treatment of aggressive periodontitis includes the combined use of amoxicillin with metronidazole, these results highlight the need for culture and antimicrobial susceptibility investigations in patients with aggressive periodontitis prior to systemic use of antibiotics concomitantly to periodontal therapy.
伴放线放线杆菌是一种公认的侵袭性牙周炎病原体。该菌存在 7 种血清型，其毒力和分布范围因种族和地理位置而异。伴放线放线杆菌侵袭软组织的能力可能需要使用全身抗生素进行治疗，但由于地理位置的不同，其对抗生素的敏感性存在差异。
通过聚合酶链反应（PCR）确定来自英国 50 名侵袭性牙周炎患者队列的伴放线放线杆菌分离株的血清型。根据英国抗微生物化疗学会（BSAC）指南，通过纸片扩散法测定分离株对 8 种抗生素[青霉素（1U）、阿莫西林（2μg）、阿莫西林/克拉维酸（30μg）、甲硝唑（5μg）、克林霉素（2μg）、四环素（10μg）、环丙沙星（5μg）和头孢他啶（30μg）]的耐药性。
血清型 a、c、b、e 和混合血清型的流行率分别为 48%、22%、2%、2%和 12%。7 名患者（14%）分离株的血清型无法通过 PCR 推断。在 56 株测试的分离株中，100%对青霉素和甲硝唑耐药，87.5%对克林霉素耐药，83.9%对阿莫西林耐药，76.8%对头孢他啶耐药。对四环素（耐药率 8.9%）和阿莫西林/克拉维酸（耐药率 14.3%）的耐药率较低，而没有分离株对环丙沙星耐药。
与一些文献报道一致，侵袭性牙周炎的治疗建议包括阿莫西林与甲硝唑联合使用，这些结果强调了在对侵袭性牙周炎患者进行全身抗生素治疗之前，需要进行培养和抗菌药物敏感性检测，同时进行牙周治疗。
