Ricardo Grillo, Lázaro Caixeta, Mariana Brozoski, Fernando Melhem-Elias
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Abstract
Objectives: Odontogenic infections represent a significant clinical challenge in maxillofacial surgery due to their potential for rapid progression and life-threatening complications. Regional variations in microbial profiles and antibiotic resistance patterns directly influence treatment efficacy, underscoring the necessity for geographically tailored antimicrobial strategies. This study systematically evaluated the global microbial epidemiology of odontogenic infections, analyzing prevalent pathogens, emerging resistance trends, and the clinical effectiveness of current antibiotic regimens across different regions.
Methods: We conducted a comprehensive PubMed search, identifying 162 eligible studies comprising retrospective analyses, case series, clinical trials, and antimicrobial susceptibility tests. Extracted data included microbial identification results, antibiotic susceptibility profiles, and geographic variables. Statistical evaluation employed Pearson's correlation coefficients and Kruskal-Wallis tests.
Results: The analysis encompassed 20,911 patients yielding 61,408 bacterial isolates representing 123 distinct strains. No statistically significant temporal trends in microbial prevalence were detected. Geographic variations significantly affected antibiotic selection, with regional efficacy patterns being particularly evident in severe infections. Amoxicillin-clavulanate and vancomycin demonstrated consistently high susceptibility rates (> 90%), whereas the metronidazole-penicillin combination showed limited efficacy, though this finding was constrained by insufficient data availability.
Conclusions: Although surgical drainage remains the cornerstone of management, treatment outcomes can be optimized through region-specific antibiotic selection guided by local microbial patterns. Antibiograms, whenever feasible, support targeted therapy, helping address resistance patterns. Optimal antimicrobial stewardship for odontogenic infections requires continuous consideration of evolving regional resistance trends alongside potential therapeutic risks.
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