In 1999, we introduced unique oral-facial microbiology laboratory combining a dental research laboratory and a hospital microbiology laboratory. A specifically designed clinician computer order-form utilized the hospital Laboratory Information System; empiric antibiotic selection was one of the 16 clinical/microbiologic parameters requested.
Objectives:
Reviewing the computerized data, our objectives were to retrospectively track: 1) empiric selection of antimicrobials, 2) comparison of the empiric selection with the in vitro antibiotic resistance report, and 3) comparison to Team Dentistry recommendations.
Methods:
WVU SoD Clinic or private patients with periodontal disease and/or implants had cultures taken for: 1) management, 2) test of cure, or 3) follow-up/progression. Data in an excel spreadsheet was merged with the Sunquest LIS. Viable organisms and bio-load (CFUs/ml) were calculated using standard microbial methods. Six antibiotics were assayed by the Etest. Three periodontists, supported by a pharmacist and a clinical microbiologist made up the Team Dentistry.
Results:
Of the 115 patient results analyzed, 62% did not list drug of choice, 38% did; of the latter, 70% were from the WVU SoD. Of the empiric antimicrobial therapy reported, three accounted for 80%: amoxicillin and metronidazole (44.2%); doxycycline (30%); amoxicillin (7%). Recommendations by Team Dentistry were: no antibiotics (44%), antibiotic therapy (51%), and others including, immunomodulation and/or SRP, (5%). The most frequently recommended regiments were doxycycline (54%) and amoxicillin with metronidazole (25%). In comparing the in vitro antibiotic sensitivity profile, 20% of the empiric antibiotics listed would have been potentially ineffective as the oral organism were reported as, R, Resistant, in vitro.
Conclusion:
The incorporation of a dental research and hospital laboratory as a unique oral-facial microbiology service improved the cooperation of the medical, pharmacy, and dental schools. Of particular importance was the effectiveness in educating dentists in the consequences of antibiotic resistance due to incorrect empiric selection, which in our study, was 20%.