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Alveolar osteitis associated with methicillin-resistant Staphylococcus epidermidis.

Alessio Buonavoglia1, Adriana Trotta2, Marco Cordisco2

  • 1Endodontic Clinical Section, Department of Biomedical and Neuromotor Sciences, Dental School, University of Bologna, Italy

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Systemic antibiotics may be ineffective for treating alveolar osteitis, particularly when caused by multidrug-resistant bacteria. This case highlights the challenges of antimicrobial resistance in dental post-operative complications.

Keywords:
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Area of Science:

  • Dentistry
  • Microbiology
  • Infectious Diseases

Background:

  • Empiric broad-spectrum antibiotic use in dentistry can escalate antimicrobial resistance.
  • Alveolar osteitis is a common post-operative complication with controversial antibiotic treatment guidelines.

Observation:

  • A patient with cracked tooth syndrome and pulpitis experienced purulent bleeding after extraction.
  • Bacteriological analysis identified methicillin-resistant Staphylococcus epidermidis (MRSA).
  • The isolate exhibited resistance to multiple antibiotics, including azithromycin.

Findings:

  • The patient initially treated with cefixime showed limited improvement.
  • Subsequent treatment with azithromycin was administered alongside socket irrigation.
  • Complete resolution of alveolar osteitis was observed within 7 days.

Implications:

  • Systemic antibiotics may have insufficient efficacy in treating alveolar osteitis caused by multidrug-resistant organisms.
  • This case underscores the critical need for targeted antimicrobial therapy based on susceptibility testing.
  • Managing post-operative complications requires careful consideration of local and systemic antimicrobial resistance patterns.