Microbiology of postoperative infections after third molar surgery: A systematic review of case reports

Background: Antibiotic treatment for a clinical infection should be based on a thorough knowledge of the causative organisms involved in the infection. Methods used to evaluate microbiology should provide a comprehensive and accurate assessment of the microbiological spectrum. Currently, there is limited evidence on the microbiology of postoperative infection after third molar surgery, leading to inappropriate antibiotic prescription. Aim: The objective of this review was to summarize the current documented evidence on bacteriology of postoperative infection samples after third molar surgery with a systematic search of the literature. Results: A systematic search was performed in three databases (PubMed, Web of Science, and Medline-Ovid) on March 17, 2017 with no filters applied. After exclusion of duplicates, 142 records were screened, based on predetermined exclusion criteria and finally, 11 case reports recording microbiological data for clinical infection samples were selected. The most common genus of organisms isolated from third molar infections was Streptococcus. Anaerobic species dominated in cases where prior antibiotic treatment was initiated. However, documented microbiological data are only culture based and predominantly report fascial space infections after third molar surgery. Conclusion: Culture-based methods may not be accurately representing the true microbial profile of postoperative infections. There is an urgent need for comprehensive microbiological data employing next-generation sequencing techniques on postoperative infections to prevent inappropriate antibiotic prescription. Clinical significance: Prescribing broad spectrum antibiotics to treat postoperative infections with inadequate information on the microbiology is a questionable clinical practice that propagates antibiotic resistance. Clinicians should utilize recent advances in microbiological diagnosis to reduce unsuitable antibiotic prescription.