Evaluation of Microbial Flora and Antibiotic Susceptibility of Facial Cellulitis Related to Dental Infection

Author(s): Shashi Kishore1 , Rashmi2 , Arjun Lal3

BACKGROUND Historically, the potential for a dental abscess to spread causing severe sepsis and death has been known since antiquity although the role of bacteria in this process was not recognized until the turn of the 20th century. Cellulitis is a bacterial skin and soft tissue infection which occurs when the physical skin barrier, the immune system and/or the circulatory system are impaired. The acute dental abscess is usually polymicrobial and gram-positive cocci such as Streptococcus spp. and staphylococcus aureus thought to be the predominant organisms associated with facial cellulitis. We wanted to isolate and identify the organisms in jaw cellulitis cases and determine the current antibiotic susceptibility pattern. METHODS The study was conducted on 53 patients attending the OPD. The orthopantomogram (OPG) was performed on admission. Patient were included regardless of any previous antibiotic or anti-inflammatory treatment. The pus sample collected by swab method and sent for bacteriological examination in laboratory. For culture the samples were studied for identification of isolates by gram stains and culture growth on nutrient, blood and MacConkey agar. Colonies from nutrient agar was used for biochemical tests and antibiotic sensitivity. RESULTS Out of a total of 53 cases studied, 46 cases showed growth of microorganisms. In 7 cases, there was no growth. The predominant bacterial isolate was analysed in each case and a total of 12 types of bacteria were isolated. Among them gram positive cocci such as Streptococcus species (26.08%) and staphylococcus (17.39%) found to be predominant organisms in facial cellulitis. CONCLUSIONS The acute dental abscess which leads to cellulitis is usually polymicrobial, comprising of facultative anaerobes, such as viridans group of streptococci and Streptococcus anginosus group, with some predominant strict anaerobes.