Emerging Trends Of Odontogenic Infections In Diabetic Patients: A Scoping Review Of Microbial Patterns And Resistance Mechanisms

Abstract

Background: Diabetes mellitus impairs immune function, increasing the risk of rapid progression of odontogenic infections to cellulitis and deep neck space infections, as well as antibiotic resistance.

Objectives: To evaluate the oral microbiota in odontogenic infections among diabetic patients, identify microbial shifts, and assess antibiotic resistance patterns.

Methods: A scoping review was conducted across multiple databases using predefined inclusion and exclusion criteria.

Results: Nine studies met the criteria, including prospective, retrospective, descriptive, case report, and epidemiological designs. Middle-aged males were more commonly affected. The main sources of infection were posterior teeth, pericoronitis, dentoalveolar abscesses, and space infections, with all cases classified as space infections of odontogenic origin. Dental caries was the most frequent cause, with single cases of pericoronitis, necrotizing fasciitis, and periodontitis. The submandibular space was most often involved. Streptococcus spp. predominated, followed by MRSA, Klebsiella, Staphylococcus, and Acinetobacter spp. Streptococcus spp. showed high resistance to penicillin, amoxicillin, and amoxicillin–clavulanic acid. MRSA was resistant to most antibiotics except vancomycin, while Klebsiella showed resistance to amoxicillin–clavulanic acid.

Conclusions: In diabetic patients, odontogenic infections typically arise from posterior teeth and frequently involve the submandibular space. Streptococcus spp. is the predominant pathogen, with notable resistance to commonly prescribed antibiotics. Prompt diagnosis and targeted antimicrobial therapy are essential to prevent severe complications.