Zhiltsov I.V., Semenov V.M., Dmitrachenko T.I., Egorov S.K., Torosyan T.A., Prudnikov A.R.
The nature of beta-lactamase activity of the oral fluid
Education establishment "Vitebsk State Order of Peoples’ Friendship Medical University"
Abstract.
The objective of this research was to clarify the mechanisms of the oral microflora resistance and to identify the endogenous resistance to beta-lactam antibiotics. We investigated the oral fluid of 75 patients with purulent-inflammatory diseases of the oral cavity, and 40 practically healthy individuals. The determination of beta-lactamase activity of the oral fluid was carried out with nitrocefine method using the test system «BioLactam». For beta-lactamase activity inhibiting tazobactam with a final concentration of 5 mg/ml was added to the oral fluid. For albumin binding a suspension of Blue SepharoseTM granules was added to the oral fluid samples (10 samples). Fractionation of proteins of the oral fluid was performed using preparative disk electrophoresis in 7,5% polyacrylamide gel. The disk diffusion method was used to assess the stability of 43 isolates of S. aureus to beta-lactams. The average level of beta-lactamase activity of the saliva was 41,4% (95% CI: 31,3…50,6). Beta-lactamase activity of the saliva ≥45% indicates a high probability of penicillins (including aminopenicillins) and 1-3 generations cephalosporins clinical failure (sensitivity – 75,0%, specificity – 89,6%, p <0,0001). All endogenous host factors cause about 20% of the total level of beta-lactamase activity of the oral fluid, the remaining 80% come from the bacterial beta-lactamases of class A. S. aureus strains produce beta-lactamases, non-ESBL, due to which they exhibit their resistance only to penicillins, 1-2 generations cephalosporins, and aminopenicillins. Resistance to beta-lactam antibiotics in S. aureus can significantly more often (p=0,0015) be explained by non-enzymatic mechanisms than by the production of beta-lactamases, among which ESBL almost never occur. The obtained findings should be taken into account when prescribing the starting empiric antibacterial therapy for purulent-inflammatory diseases of the maxillofacial area.
Key words: beta-lactamase activity, oral fluid, assay kit «BioLactam», empiric antibacterial therapy, purulent- inflammatory diseases of the maxillofacial area.
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