Severe Cases of Odontogenic Abscesses, Next-Generation Sequencing Searching for Superpathogens. Case Series and Review of Current Literature

Abstract Objectives This paper aimed to identify possible causes of complications in odontogenic abscesses. In particular, infections with specific pathogens should be highlighted. Materials and Methods We report on two young patients with odontogenic abscesses who required an extended hospitalization in the intensive care unit due to serious local (Lemierre's syndrome, mediastinitis) and systemic complications. During the extraoral abscess incision, we obtained sequencable wound swabs and carried out genetic microbiological diagnostics using next-generation sequencing (NGS) searching for superpathogens. Besides the conducted analysis, the article summarises the current literature on the microbiome of odontogenic abscesses and its analysis using gene-based microbiological techniques. Results Microbiological analysis revealed a polymicrobial infection characterised by anaerobic bacteria with microorganisms such as Prevotella or Peptostreptococcus in both patients. In addition, the particularly virulent pathogen Fusobacterium necrophorum was detected in one patient. Conclusions Infections with specific pathogens such as Fusobacterium necrophorum should be considered as possible triggers of complications in patients with odontogenic abscesses. Gene-based microbiological analysis is a valid and rapid technique for pathogen detection and should be used in particular for atypical, severe treatment courses in order to enable pathogen detection and targeted antibiotic therapy.