A two-centre retrospective study on the microbiology of bisphosphonate associated osteonecrosis of the jaws

Abstract number: P1415

Jackson M., Snäll J., McFadzean R., Smith A., Rautemaa-Richardson R.

Objective: Bisphosphonate associated osteonecrosis (BON) of the jaws is a side effect of bisphosphonate therapy, which is commonly used in the management of osteoporosis, multiple myeloma and bone metastasis. The bisphosphonates act by inhibiting bone resorption resulting in an interference with the normal process of bone turnover. This creates the potential for aseptic necrosis of bone which may subsequently become infected. The mandible in particular appears at heightened risk for BON. There is very little information in the literature concerning the microbiology of infected BON of the jaws. The aim of this study was to determine the microbiology of specimens from BON lesions of the jaws.

Method: A review of cases with a clinical history of BON was determined by a data-base search over the period 2005–2007 (Helsinki) and by hand searching laboratory records over the period 2006–2009 (Glasgow), submitted to the respective regional diagnostic oral microbiology laboratories.

Results: In Helsinki (He), 18 cases of BON of the jaws were identified. Of these, specimens had been submitted for microbiological analyses in 11 cases. In Glasgow (Gl) 14 specimens had been analysed. All specimens demonstrated mixed growth comprising Actinomyces spp. (8/11 specimens He, 2/14 Gl), S. anginosus group (2/11 He, 5/14 Gl), anaerobic cocci (4/11 He, 3/14 Gl) and anaerobic Gram negatives such as Prevotella and Fusobacterium spp (8/11 He, 1/14 Gl) in addition to Viridans group streptococci (10/11 He, 8/14 Gl). Many isolates demonstrated reduced susceptibility to penicillin and macrolides. Resistance to clindamycin was more common than to doxycyclin.

Conclusions: Our results from this small cohort of patients with infected BON of the jaws demonstrates that Actinomyces spp, Streptococcus spp. and Gram negative anaerobes are the predominant findings, many with reduced antimicrobial susceptibility. Clinicians should be encouraged to submit appropriate samples to aid in the management of this condition. This data should be considered when proposing guidelines for prophylaxis and therapy of infected BON of the jaws. It appears that the choice and duration of empiric antimicrobial therapy should be directed towards Actinomyces spp. Laboratory protocols should include prolonged culture for these slowly growing facultative and anaerobic pathogens.

Session Details

Date: 10/04/2010
Time: 00:00-00:00
Session name: Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases
Location: Vienna, Austria, 10 - 13 April 2010
Presentation type:
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