Prevalence, Proportions, and Identities of Antibiotic-Resistant Bacteria in the Oral Microflora of Healthy Children

Background Antibiotic resistance is a global health concern, yet research on the identities and proportions of antibiotic-resistant bacteria in the oral microflora of healthy children remains limited. These resistant bacteria could play a role in various conditions, such as dental infections, periodontitis, or systemic infections following dental procedures, particularly in immunocompromised individuals. This study aimed to assess the prevalence, proportions, and identities of antibiotic-resistant bacteria in the oral microflora of healthy children. Methodology This cross-sectional study, conducted from January to December 2023 across three tertiary care hospitals in Peshawar, Pakistan, involved 364 healthy children aged 7-13 years. Data on antibiotic use were collected via structured interviews and medical records, detailing specific antibiotics (e.g., amoxicillin, ceftriaxone, azithromycin), including dosage, duration, and reason for use. Oral swabs were taken from various sites in the oral cavity using sterile techniques and analyzed using microbiological culture methods and polymerase chain reaction to identify antibiotic-resistant bacteria. Statistical analysis was performed with SPSS version 27.0, utilizing chi-square tests to explore associations between demographic factors and resistance patterns, with significance set at p < 0.05. Results Significant proportions of antibiotic use were found among the participants: 172 (47.25%) received penicillins, 91 (25.00%) cephalosporins, and 101 (27.75%) macrolides, with associated side effects including gastrointestinal disorders and allergic responses. Age and gender differences were observed in antibiotic resistance proportions: among 7-9-year-olds, resistance to penicillins was 44 (18.33%), to cephalosporins 29 (12.08%), and to macrolides 33 (13.75%). In contrast, among 10-13-year-olds, these proportions increased to 55 (22.92%), 36 (15.00%), and 43 (17.92%), respectively. Male participants exhibited resistance to cephalosporins at a proportion of 24 (10.00%), to macrolides 45 (18.75%), and to penicillin 46 (19.17%), while female participants showed proportions of 53 (22.08%), 41 (17.08%), and 31 (12.92%), respectively. Among oral swab locations, the buccal mucosa had the highest resistance proportions: 35 (14.58%) to penicillins, 27 (11.25%) to cephalosporins, and 33 (13.92%) to macrolides. Specific bacterial species showed distinct resistance patterns, with notable proportions observed in <i>Staphylococcus aureus</i> (n=18; 50.00%, n=12; 33.33%, and n=6; 16.67%, respectively), <i>Escherichia coli</i> (n=16; 40.00%, n=10; 25.00%, and n=14; 35.00%, respectively), <i>Enterococcus faecalis</i> (n=29; 45.31%, n=14; 21.88%, and n=21; 32.81%, respectively), and <i>Klebsiella pneumoniae</i> (n=19; 36.54%, n=13; 25.00%, and n=20; 38.46%, respectively). Conclusions This study focused on healthy children aged 7-13 years in Peshawar, Pakistan, to assess the prevalence and types of antibiotic-resistant bacteria in their oral microbiota. The findings highlight resistance patterns by age, gender, and bacterial species. However, the regional context may limit the generalizability of these results. Differences in local antibiotic use, healthcare practices, and environmental factors could influence resistance patterns in other regions. Future research should expand to include diverse geographic locations to evaluate the broader applicability of these findings and identify region-specific factors affecting antibiotic resistance.