DYNAMICS OF THE MICROBIOLOGICAL SPECTRUM OF ODONTOGENIC INFECTIONS OF THE MAXILLOFACIAL FASCIAL SPACES: RESULTS OF A RETROSPECTIVE- PROSPECTIVE STUDY

Abstract

In Ukraine, purulent-necrotic infections involving the fascial spaces of the floor of the mouth and neck remain a significant clinical problem and may result in life- threatening complications and occasional fatal outcomes. Given the crucial role of microbial pathogens in the etiology and clinical severity of odontogenic purulent- necrotic infections of the maxillofacial soft tissues, investigating changes in the microbiological profile of odontogenic cellulitis is of substantial scientific and practical importance. Objective. To perform a comparative analysis of the microbiological spectrum of postoperative wounds in patients with odontogenic purulent-necrotic infections of the maxillofacial fascial spaces based on retrospective and prospective data. Materials and methods. A retrospective analysis of bacteriological findings obtained from patients with odontogenic cellulitis treated during 2022–2024 was performed. In addition, a prospective study included 107 patients with odontogenic purulent-necrotic infections of the maxillofacial fascial spaces treated in 2024–2025. Postoperative wound exudate was subjected to microbiological examination with identification of microorganisms, assessment of bacterial contamination levels, and antimicrobial susceptibility testing. Results. Positive bacterial growth was detected in 83 (77.6%) patients. The predominant microbial families were Streptococcaceae (34.9%), Staphylococcaceae (21.7%), and Pseudomonadaceae (15.7%). Polymicrobial associations were identified in 31.3% of cases. Low bacterial contamination (≤10³ CFU/mL) was observed in 68.7% of postoperative wounds, whereas high bacterial load (≥106 CFU/mL) was detected in 21.7% of patients. Clindamycin demonstrated the highest antimicrobial activity against the isolated microorganisms. Comparative analysis revealed a marked decrease in the prevalence of Streptococcaceae from 80.8% to 34.9% and an increase in Pseudomonadaceae from 0% to 15.7% over the study period. Conclusions. The current microbiological profile of postoperative wounds in odontogenic purulent- necrotic maxillofacial infections is characterized by the persistence of streptococcal and staphylococcal flora, an increased proportion of opportunistic Gram-negative microorganisms, particularly Pseudomonas aeruginosa, and a high prevalence of polymicrobial associations. These findings indicate an ongoing transformation of the microbial spectrum and highlight the importance of continuous local microbiological surveillance and regular revision of empirical antibiotic therapy protocols.