Artículo de revisión

Published on 8 de abril de 2025 | http://doi.org/10.5867/medwave.2025.03.2938

Oral and oropharyngeal colonization by Enterobacteriaceae: A narrative review on its epidemiology and clinical impact

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Set of included studies and eligible variables.
EvidenceNumber of participantsAge (years)GenderType of sampleMicrobial identification methodPrevalence of oral colonizationPrevalence of OP colonizationProportion of isolates with antimicrobial resistanceSpecies profile
Costa C et al., 2021 [26]87Not specifiedNot specifiedSaliva collectionMALDI-TOF43.20%-Amoxicillin 83%, sulfamethoxazole 43%, ciprofloxacin 35%, streptomycin 17%Raoultella ornithinolytica
Leão-VasconcelosL et al., 2015 [34]294Not specifiedF, M (Lack of quantitative distribution)Sample of unstimulated salivaGram stain, biochemical screening, and classification tests (indole production; presence of motility; ornithine, arginine, and lysine decarboxylation)18.70%-Amoxicillin/clavulanic acid 57.8%Enterobacter gergoviae, Enterobacter sakasaki, Enterobacter aerogenes, Klebsiella pneumoniae, Citrobacter koseri, Pantoea aglomerantes, Klebsiella oxitoca, Escherichia coli, Enterobacter cloacae, Citrobacter amalonaticus, Citrobacter freundii, Serratia marcescens
Valenti WM et al., 1978 [35]407> 65F:294M:113Oropharyngeal culture by throat swabAgar Mac Conkey-40%-Klebsiella spp., Escherichia coli, Enterobacter spp., Proteus mirabilis
Le MN-T et al., 2020 [36]9855 to 101F:69M:29Oropharyngeal swabVitek-2 system, 16S rDNA sequencing, and MALDI-TOF MS-Biotyper-38%Ampicillin 100%, piperacillin 12.5%, cefazolin 62. 25%, ceftazidime 37.5%, cefotaxime 37.5%, cefozopran 12.5%, cefpodoxime 37.5%, ciprofoxacin 12.5%, fosfomycin 25%Klebsiella spp., Escherichia coli, Enterobacter cloacae, Raoultella planticola, Rahnella spp.
Atarashi K et al., 2017 [37]---Saliva samples from two patients with Crohn’s disease were transferred to germ-free mice-----
Chinnasamy A et al., 2019 [27]1506 to 17F: 104M:46Mouthwash samples with 10 ml of phosphate-buffered salineBlood agar and MacConkey plus Vitek 2 system72%--Escherichia coli, Enterobacter aerogenes, Klebsiella spp., Enterobacter cloacae.
Kamal FG, Bernard RA, 2015 [28]1008 to 15Not specifiedSample of mouthwash with 10 ml of phosphate-buffered saline solutionCulture media: MacConkey agar and blood agar. Oxidase test, indole test, methyl red test, Voges-Proskauer test.42% onychophagy, 30% digital suction--Escherichia coli, Klebsiella spp., Proteus spp. and Enterobacter spp.
Conti S et al., 2009 [38]10030 to 50F: 50M:50Samples of plaque collected from the dorsum of the tongue in the circumvallate papillae regionAgar MacConkey plus API 20E system43% on the back of the tongue--Enterobacter cloacae, Pantoea spp, Klebsiella oxitoca, Klebsiella rhinoscleromatis, Shigella spp., Pantoea spp., Yersinia enterocolítica, Klebsiella pneumoniae, Enterobacter cancerogeno, Klebsiella ornithinolytica, Klebsiella ozaenae
Baydas B. et al., 2007 [29]5911.9 and 16.5F: 35M:24Mouthwash samples with 10 ml of phosphate-buffered saline solutionMacConkey agar and blood agar47.46%--Enterobacter aerogenes, Escherichia coli, Enterobacter cloacae and Enterobacter gergoviae
Goncalves M. et al., 2007 [30]8035 and 60F: 36M:44Paper-tip samples inserted in periodontal pocketsMacConkey agar CLED agar--Ampicillin 75%, amoxicillin/clavulanic acid 25%, aminoglycosides 5%, tetracycline 25%, sulfamethoxazole/trimethoprim 5% and chloramphenicol 8%.Enterobacter cloacae, Enterobacter aerogenes, Pantoea agglomerans, Serratia marcescens, Klebsiella pneumoniae, Citrobacter freundii.
Hägg U et al., 2004 [31]50average age 15.5 ± 2.4F: 26M:24Mouthwash with 10 ml of phosphate-buffered saline solution and the combined plaque methodMacConkey agar and blood agar23.40%--Klebsiella pneumoniae, Enterobacter cloacae, Enterobacter sakazakii, Enterobacter cloacae, Enterobacter gergoviae, Enterobacter aglomerantes
Pathak A, Sharma D, 2013 [32]2510 and 14Not specifiedThe retainers were placed in 10 ml of phosphate-buffered saline solutionCandida Hichrome agar, eosin methylene blue agar, UTI Hichrome agar, tryptone glucose yeast extract agar, blood base agar medium---Not specified
Sreela LS et al., 2017 [39]100Not specifiedNot specifiedMouthwash samples with 10 ml of phosphate-buffered saline solutionAgar blood and agar Mac Conkey58%-Amoxicillin 80%, cephalexin 70%, amoxicillin-clavulanic acid 70%, cefotaxime 63% and ceftriaxone 63%Citrobacter spp., Escherichia coli, Enterobacteria, Klebsiella spp.
Pontes L et al., 2022 [40]362≥ 18Not specifiedSubgingival biofilm samples with sterile curettes in the most apical portion of the sulcus/pocketPlates with selective agar for gram-negative bacilli36.20%-Cefoxitin 50.9%, amoxicillin-clavulanate 43.3%, cefazolin 42.9%Enterobacter cloacae, Enterobacter asburiae, Klebsiella pneumoniae, Escherichia spp., Serratia spp., Citrobacter spp., Proteus spp., Pantoea spp.
Jepsen K et al., 2022 [41]16.61211 and 89Not specifiedSamples of deep periodontal pocket biofilmsSheep blood agar, lactose blue agar, and Kimmig agar5%-Amoxicillin/clavulanic acid 79.1%, doxycycline 37.7%Enterobacter cloacae, Klebsiella oxytoca , Klebsiella pneumoniae, Serratia marcescens, Serratia liquefaciens.
Vieira A et al., 2016 [42]270≥ 18Not specifiedSamples of subgingival biofilm from 7 healthy sites, 7 sites with periodontitis; 7 sites with gingivitisDNA-DNA hybridization40%--Serratia marcescens, Klebsiella pneumoniae

Abbreviations, MALDI-TOF. matrix-assisted laser desorption/ionization. MDR-E, multidrug-resistant enterobacteria. 16S rDNA, 16S ribosomal DNA. OP, oropharynx. M, male. F, female.

Source: Prepared by the authors based on study results.