Clinical impact of antibiotic resistance in odontogenic infections: a 12-year analysis of 740 cases

Objectives This study aimed to investigate the microbial spectrum and resistance patterns in surgically treated odontogenic infections and to assess the clinical impact of resistance, including systemic complications and hospitalization. Resistance rates were additionally evaluated in relation to reported penicillin hypersensitivity. Methods A total of 740 inpatient cases with microbiological testing from surgically treated odontogenic infections at the Jena University Hospital from January 1, 2012, to December 31, 2023, were analyzed. Resistance rates were assessed at infection level. Time trends were analyzed using Poisson regression. Associations between resistance rates and clinical variables were evaluated using binary logistic regression. Results Clindamycin resistance was observed in 38.9% of infections, while amoxicillin/clavulanate (6.9%) and moxifloxacin (4.5%) showed lower resistance rates. No statistically significant trends in resistance rates were observed. Moxifloxacin resistance increased the risk of systemic complications (OR: 10.875; 95%-CI: 1.028–115.108; p  = 0.047), while no significant associations were found between antibiotic resistance and prolonged hospitalization. A history of penicillin hypersensitivity was associated with increased clindamycin resistance (OR: 2.156; 95%-CI: 1.038–4.480; p  = 0.04). Conclusions Clindamycin exhibits high resistance rates in odontogenic infections and should be critically re-evaluated as empirical therapy, especially in patients with penicillin hypersensitivity. Given the overall low resistance rates to moxifloxacin, resistance to this agent indicated highly resistant infections and was associated with an increased risk of systemic complications. Clinical relevance: Continuous resistance surveillance and adaptation of empirical therapy are essential for managing severe odontogenic infections and reducing life-threatening infection-related complications, emphasizing the need for antimicrobial stewardship.