Microorganisms from canals of root-filled teeth with periapical lesions and the antimicrobial susceptibility to different antibiotics of enterococcus faecalis isolates

Author(s)

Ericka Tavares Pinheiro

• Document type: Doctoral Thesis
• Press: Piracicaba, SP.
• Institution: Universidade Estadual de Campinas (UNICAMP). Faculdade de Odontologia de Piracicaba
• Defense date: 2005-01-31

Examining board members

Brenda Paula Figueiredo de Almeida Gomes; Marcia Pinto Alves Mayer; Antonio Olavo Cardoso Jorge; Antonio Carlos Bombana; Francisco José de Souza Filho

• Advisor: Brenda Paula Figueiredo de Almeida Gomes

Abstract

The objectives of the present study were to identify the microbial flora within root canals of teeth with failed root canal treatment, and to test, in vitro, the susceptibility of Enterococcus faecalis isolates. Sixty root-filled teeth with persisting periapical lesions were selected for this study. During nonsurgical endodontic re-treatment, the root-filling material was removed and the canals were sampled. Microbial sampling, isolation and species determination were performed using advanced microbiologic techniques for anaerobic species. Additionally, 21 Enterococcus faecalis isolates were tested for their antibiotic susceptibilities to benzylpenicillin, amoxicillin, amoxicillin-clavulanic acid, erythromycin, azithromycin, vancomycin, chloramphenicol, tetracycline, doxycycline, ciprofloxacin and moxifloxacin. Minimal inhibitory concentrations (MICs) for the antimicrobial agents were determined using the E-test System. The strains were also tested for ß-lactamase production with nitrocefin. Microorganisms were recovered from 51 teeth. In most cases, one or two strains per canal were found. Of the microbial species isolated, 57.4% were facultative anaerobic species and 83.3% Gram-positive microorganisms. Enterococcus faecalis was the bacterial species most frequently recovered. Obligate anaerobes accounted for 42.6% of the species and the most frequently isolated genera was Peptostreptococcus. Significant associations were observed between pain or history of pain and polymicrobial infections or anaerobes (p<0.05). All Enterococcus faecalis strains were susceptible to penicillins in vitro, however, the MICs of amoxicillin and amoxicillinclavulanic acid (MIC90= 0.75 µg/ml) were lower than for benzylpenicillin (MIC90= 3.0 µg/ml). All strains studied were also susceptible to vancomycin and moxifloxacin, while 95.2% were susceptible to chloramphenicol. Among the isolates, 85.7% were susceptible to tetracycline and doxycycline, and 80.9% to ciprofloxacin. The MIC of erythromycin ranged from 0.38 to >256 µg/ml; only 28.5% of the strains were susceptible (MIC =0.5 µg/ml). Limited susceptibility was also observed with azithromycin which was active against only 14.2% of isolates. No strains produced ß-lactamase. Therefore, it was concluded that the microbial flora in canals after failure of root canal treatment were limited to a small number of predominantly Gram-positive microbial species. Facultative anaerobes, especially Enterococcus faecalis, were the most commonly isolated microorganisms, however, polymicrobial infections and obligate anaerobes were frequently found in canals of symptomatic root-filled teeth. Enterococcus faecalis isolates were completely susceptible, in vitro, to amoxicillin, amoxicillin-clavulanic acid, vancomycin, and moxifloxacin. Most isolates were susceptible to chloramphenicol, tetracycline, doxycycline, or ciprofloxacin. Erythromycin and azithromycin were least effective (AU)