Antibiotic resistance: a case of a chronic maxillofacial osteomyelitis complicating an odontogenic cellulitis

Abstract

Introduction and importance: The post-antibiotic era is here. Oral diseases affect about half of the world’s population, and hence, antibiotic resistance can have serious consequences given that antibiotics are the cornerstone of modern medicine. Nowadays, with the massive, abusive use of antibiotics, we are forcing bacteria to mutate genetically in order to survive. This antibiotic Darwinism creates resistant bacterial strains that encroach on practitioners’ therapeutics. The European Centre for Disease Control estimates that 25 000 people die every year as a result of antibiotic resistance. Case presentation: We describe a case of antibiotic resistance in dentistry. The patient was a 29-year-old female referred to the Odontostomatology unit for management of a chronic left facial swelling. The swelling had been accompanied for 3 days by intense otalgia, projected to the left ear, and an oro-antral discharge that interfered with eating. The patient had a history of self-medication. Clinical discussion: An initial diagnosis of a chronic osteomyelitis complicating odontogenic cellulitis was made. We administered probabilistic antibiotics while awaiting the results of the antibiogram (which took 2 weeks). Once we had the results, we changed the antibiotic therapy to one of certainty, with no real change in the course of the infection. We performed a surgical intervention to eliminate the bone sequestrations. Nevertheless, we continued with our twice-daily local debridement with no major improvement still. The patient unfortunately passed away. This is the first case of antibiotic resistance in dentistry described in Cameroon to the best of our knowledge. Conclusion: Antimicrobials are essential medicines for health, but in recent years, some bacteria have demonstrated partial or total resistance to various antimicrobial agents. This phenomenon, known as antibiotic resistance, is a matter of public health concern. Several factors are associated with the emergence of microbial resistance: widespread and inappropriate use of broad-spectrum antibiotics, such as treatment of viral diseases with antibiotics.