ESKAPE pathogens: Emerging isolates in odontogenic orofacial infections

Odontogenic orofacial infections involve a broad microbial spectrum, with the rise of multidrug-resistant organisms complicating management. ESKAPE pathogens, known for their ability to evade standard antimicrobial therapies, are increasingly implicated in severe infections. However, their prevalence and resistance patterns in odontogenic orofacial space infections remain insufficiently reported. This study aimed to identify the occurrence of ESKAPE pathogens in such infections and assess their antimicrobial susceptibility to guide effective treatment.

Between August 2019 and June 2022, 132 patients with oral and maxillofacial infections were prospectively enrolled. Pus samples collected using sterile swabs were cultured following standard protocols. Bacterial identification and susceptibility testing were performed using the VITEK 2-Compact system.

Twenty-nine samples (21.97%) yielded at least one ESKAPE pathogen, with Enterobacter species being the most common isolate (34.48%). High resistance rates were seen to amoxicillin-clavulanic acid (62.07%), cefuroxime (62.5%) and trimethoprim-sulfamethoxazole (68.42%). Linezolid, ertapenem, and clindamycin demonstrated the highest susceptibility (100%), followed by imipenem (86.96%, p ≤ 0.05). Acinetobacter baumannii demonstrated complete resistance to all tested antibiotics.

ESKAPE pathogens represent a significant proportion of odontogenic orofacial infections and exhibit considerable resistance to commonly used antibiotics. These findings reinforce the necessity of culture-based therapy and highlight imipenem as a potential option for resistant cases. Strengthened antibiotic stewardship and continued surveillance are essential to manage the growing threat of multidrug-resistant organisms in maxillofacial infections.