Odontogenic infection in the oral and maxillofacial regions caused by bacteria (mostly of oral origin) is one of the most common diseases encountered by dentists . Localized infection can easily be treated with incision and drainage (I&D) followed by antibiotics. However, it can spread rapidly to other spaces and cause severe problems such as sepsis, airway obstruction, necrotizing fasciitis and mediastinitis [2-4]. Odontogenic infection is polymicrobial in nature, comprising of various facultative anaerobes, such as the
Literature search was performed in Medline, PubMed and Google Scholar ranging from 2012 to 2020, using keywords, including “ESKAPE pathogens”, “
This study found 16 articles from 2012 to 2020 in Medline, PubMed and Google Scholar and performed comparative analysis. As shown in Tables 1 and 2, articles discussed various bacterial infection on different sites. This study specifically focused on ESKAPE bacteria. Of the 16 articles reviewed in this paper, 11 articles studied medical and systemic infection, and only 5 articles studied oral and maxillofacial infection, mostly of dental origin (Tables 1, 2). Empirical antibiotics were first administered, and culture was performed to identify bacteria type and antibiotic sensitivity. With the result of culture test, carbapenem was most commonly used, and vancomycin was mainly used in
The problem of infection has continued to exist even after the introduction of antibiotics and the emergence of antibiotic resistant bacteria (ARB) has become a worldwide issue that threatens individual healthcare, economic and social welfare [10-12]. Despite increased efforts in recent years, the problem of ARB continues to grow [9,13]. Especially, ESKAPE pathogens are mostly resistant to antibiotics and the risk of infection is growing due to mechanisms including inactivation or alteration of antimicrobial molecule, modification of the site of action, inhibition of cell membrane function, and reduction of antibiotic penetration/accumulation [11,14,15]. Extensive resistance to antibiotic requires discreet infection prevention, development of new antibiotics and treatment methods. Most previous studies reported on systemic infections in medical field caused by ESKAPE pathogens and different antibiotics that effectively treat ARB.
Only a few researches have been performed on ESKAPE infection and treatment of oral and maxillofacial region. Among the various bacteria,
However, methicillin resistance should also be taken into consideration in clinical situation. Most common methicillin-resistant
These MRSA strains are resistant to many antibiotics such as β-lactam antibiotic, aminoglycosides, macrolides, and choloramphenicol . In most cases, glycopeptide antibiotics, such as vancomycin and teicoplanin, are used as first-line of antibiotics for of MRSA infections [11,28,29]. Emergence of vancomycin-resistant
Like other bacteria, infection of
Carbapenems are conventionally used to treat persistent infections caused by gram-negative bacteria and were first administered to other ESKAPE bacteria except for MRSA, and it can be used in conjunction with colistin to treat
Various antibiotics are being administered depending on the bacteria, and antibiotic resistance is developed accordingly. Inadequate use of antibiotics increases the risk of drug resistance, leading to impairment of a patient's condition. For effective treatment of ARB, early diagnosis is essential .
Early detection of causative agents and selection of corresponding antibiotic is stressed [12,52]. Empirical prescription of antibiotics and antibiotic-susceptibility test (culture test) should be performed . Based on the results of culture testing, non-resistant and sensitive antibiotics must be selected and treated. Evaluating the patient's clinical condition is also important. If other bacteria are found in culture test, it is necessary to see if they respond to the currently prescribed antibiotics. In other words, the most appropriate antibiotics should be selected in cooperation with the Infectious Disease Department. Many papers suggest that immunosuppressed patients are more susceptible to infection [32,33]. An article studied patients with human immunodeficiency virus  and another article studied with diabetes mellitus [22,40]. In diabetic patients, certain infections were more predominant, and some outbreak appeared almost exclusively. Diabetes was also associated with increasing severity of the infections and increased chance of complication. Diabetic patients had compromised immune system in several aspects . Accordingly, systemic conditions can influence the progress of infection, and patient's comprehensive health condition is crucial in the course of treatment.
However, according to other studies, the frequency of infection by ESKAPE pathogens is not significantly different from that of the non-ESKAPE group in terms of gender, the presence of systemic disease, and the frequency of occurrence by infection site [55,56]. However, it was found that the treatment period was longer in patients with systemic diseases of ESKAPE-group than in patient of non-ESKAPE group.
This study confirmed high rate of SSI and BSI by ESKAPE pathogens. Fifty percentage of the studies reported healthcare-associated infection that can be also affected adversely to patients who admitted to the intensive care units.
Most nosocomial infections can be derived from exogenous sources and transferred by either direct or indirect contact between patient, healthcare workers and contaminated objects . As a result, clinicians should be mindful to prevent infection. Especially, dentists should take proper precautions to prevent cross contamination of bacteria in the dental clinic and hospitals, where infection is easily spread by aerosols. Infection by ESKAPE pathogens is associated with a longer treatment period, higher cost of care and a higher mortality rate compared to that of non-ESKAPE pathogens [57,58]. A systematic approach to surveillance, infection prevention, antimicrobial stewardship and clinical guidelines ensures best practice for infection control and reduces the spread of antimicrobial resistance . Directing attention to the ESKAPE pathogens can better address the broader challenges of MDR.
We expect some difficulties in our study and acknowledge some limitations. First, literature reviewed in this paper did not have consensus over the definition of the outcomes. Following a single published guidance on assessment of outcomes of different infection sites should provide more statistically meaningful conclusions. Second, there was a limitation to the fundamental analysis due to lack of the number of papers on infection focused with ESKAPE pathogens in the oral and maxillofacial regions, and the gold standard treatment option cannot be proffered. Third, due to the variety of infection areas and variety of antibiotics empirically prescribed for treatment, the effect of antibiotic resistance could not be properly analyzed. Fourth, not all identified pathogens were tested against the administered antibiotics and it is difficult to analyze and compare various antibiotic resistance rates by bacteria. In the future, comparing different strains applied with the same antibiotics will yield a more meaningful conclusion. In addition, there were limitations in classifying risk factors.
Many studies worldwide reported infections associated with ESKAPE pathogens, but only limited number of studies targeted infection in oral and maxillofacial regions. Infection by ESKAPE bacteria can have fatal consequences if the cause of the infection is not properly identified and characterized in an early stage. Further research is required with more data on ESKAPE bacteria and their infection, especially in oral and maxillofacial regions.
No potential conflict of interest relevant to this article was reported.