128 Dental Journal (Majalah Kedokteran Gigi) 2025 June; 58(2): 128–134 Original article Bacterial profile and antibiotic sensitivity in silk sutures following odontectomy Rita Endriani1, Elita Rafni2, Agung Prakoso2, Wahyu Prima3, Farhan Hadi4, Azzahra Dwi Alni4, Vezi Adina Dwideta4 1Department of Microbiology, Faculty of Medicine, University of Riau, Pekanbaru, Indonesia 2Department of Dental Oral, Arifin Achmad Hospital, Pekanbaru, Indonesia 3National Cardiovascular Center Harapan Kita Hospital, Jakarta, Indonesia 4Faculty of Medicine, University of Riau, Pekanbaru, Indonesia ABSTRACT Background: Impacted teeth, hindered from erupting normally due to space constraints, obstruction by neighboring teeth, or an abnormal eruption pathway, often necessitate surgical intervention known as odontectomy. Silk sutures are commonly used in this procedure, yet they may serve as sites for bacterial colonization, potentially leading to infection. Following odontectomy, antibiotics are typically prescribed. Purpose: This study aims to identify the bacterial profile adhering to silk sutures and analyze antibiotic sensitivity patterns in patients undergoing odontectomy. Methods: A descriptive study employing consecutive sampling of patients after odontectomy was conducted between May and November 2021 at Arifin Achmad General Hospital, Riau Province, Indonesia. Sutures were removed within 14 days of surgery, after which the silk was identified and subjected to antibiotic sensitivity testing using the Kirby–Bauer method. Results: Of the bacteria detected in the silk sutures, 53.7% were Gram positive, including Streptococcus sp. (33.3%) and Staphylococcus aureus (13%), and 46.3% were Gram negative, such as Enterobacter sp. (20.4%) and Klebsiella sp. (16.7%). Among the multi-resistant strains, methicillin-resistant S. aureus (MRSA) accounted for 57.1%. The Gram-positive bacteria exhibited the highest sensitivity to levofloxacin, whereas the Gram-negative bacteria showed sensitivity to ceftazidime, levofloxacin, and meropenem. Conclusion: The most dominant Gram-positive bacteria were Streptococcus sp. and S. aureus, whereas the most dominant Gram-negative bacteria were Enterobacter sp. and Klebsiella sp. Levofloxacin, ceftazidime, and meropenem emerged as the most effective antibiotics following odontectomy. Multidrug-resistant bacteria, exemplified by MRSA, were identified within the oral cavity. Keywords: antibiotics; bacteria; odontectomy; sensitivity; silk Article history: Received 3 July 2023; Revised 23 April 2024; Accepted 7 May 2024; Online 15 March 2025 Correspondence: Rita Endriani, Department of Microbiology, Faculty of Medicine, University of Riau, Pekanbaru, Indonesia. Jl. Diponegoro No. 1, Pekanbaru 28133 Indonesia. Email: rita_endriani_fkunri@yahoo.com INTRODUCTION Impacted teeth are those that fail to erupt into their normal position. This condition may arise due to a lack of space, obstruction by other teeth, or an abnormal eruption pathway. The prevalence of impacted teeth varies across countries. In Saudi Arabia, the prevalence of impacted teeth is 27.1%.1 In Yemen, out of 609 examined patients, 236 had impacted teeth.2 In Iraq, among 500 radiographed patients, 157 (6.28%) had impacted teeth.3 Teeth impaction can occur in any tooth, but molars, especially mandibular and maxillary third molars, are most commonly affected. The prevalence of impacted third molars ranges from 16% to 73% in young adults.4 Impacted mandibular third molars have a prevalence rate of 84.5%.2 Research by Al-Shamahy2 reported a prevalence of 38.8% for impacted third molars, with lower third molars less prevalent (15.9%) than upper third molars (22.8%). Other studies have indicated prevalence rates of 60.31% for impacted third molars, 28.73% for canines, 16.82% for second premolars, 2.81% for first premolars, 0.3% for second molars, and 0.1% for incisors.3 Treatment for impacted teeth typically involves extraction or odontectomy. Fahira et al.5 reported treating 102 cases of impacted maxillary third molars, with 12.75% of patients undergoing extraction and 87.25% undergoing Copyright © 2025 Dental Journal (Majalah Kedokteran Gigi) p-ISSN: 1978-3728; e-ISSN: 2442-9740. Accredited No. 158/E/KPT/2021. Open access under CC-BY-SA license. Available at https://e-journal.unair.ac.id/MKG/index DOI: 10.20473/j.djmkg.v58.i2.p128–134 mailto:rita_endriani_fkunri@yahoo.com https://e-journal.unair.ac.id/MKG/index https://doi.org/10.20473/j.djmkg.v58.i2.p128-134 129Endriani et al. Dent. J. (Majalah Kedokteran Gigi) 2025 June; 58(2): 128–134 odontectomy. At the General Hospital of Riau, between May and November 2021, there were 30 cases of odontectomy, primarily in women aged 15 to 55 years.6 Odontectomy involves minor surgery that closes the wound with sutures.7 Sutures are used to bridge or bind disconnected tissue and may serve as sites for bacterial colonization, potentially leading to infection.8 Sutures used after odontectomy could be continuously contaminated and become a reservoir for bacterial growth.9 Different suture materials affect the number of colonizing bacteria. Faris et al.10 reported a high accumulation of bacteria, including aerobic, anaerobic, and fungi, in silk sutures, increasing the risk of infection, inflammatory reactions, scarring, and prolonged wound healing. This occurs because sutures are made from silk and are usually multifilamentous, providing a good location for bacterial colonization because bacteria can multiply and proliferate, resulting in infection and prolonged wound healing.11 An article published by Sitorus12 reported that silk sutures, because of their multifilamentous structure, provide an ideal environment for bacterial colonization, in contrast to catgut, which offers better wound healing but is less biocompatible. Another article, published by de Castro Costa Neto et al.,13 reported that silk sutures had greater bacterial attachment than nylon, polyglactin 910, and triclosan, with a total of 1.9 ×x 105 ± 0.07 ×x 105 bacteria identified. Syaflida et al.14 revealed that the average number of bacteria found on silk sutures was 207.38 x× 107 CFU/mL, whereas the average number of bacteria attached to catgut was 115.15 ×x 107 CFU/mL, which could lead to a higher risk of infection in post-odontectomy wounds sutured by silk. Postoperative wound infections often result from Gram-positive, Gram-negative, or anaerobic bacteria. Barasa et al.15 reported that Staphylococcus aureus was the most common bacteria implicated in orofacial surgical infections, followed by Klebsiella sp., Pseudomonas sp., and Escherichia coli. In oral and maxillofacial infections, Streptococcus sp., S. aureus, and E. coli are frequently found.16 Endriani et al.6 reported both Gram-positive bacteria (52%), such as alpha-hemolytic streptococci (40.74%), S. aureus (22.22%), and coagulase-negative staphylococci (CNS) (37.04%), and Gram-negative bacteria (48%), including Klebsiella sp. (56%), Enterobacter sp. (32%), Pseudomonas sp. (8%), and E. coli (4%). The management of post-odontectomy infection typically involves peroral antibiotics. However, irrational antibiotic use may lead to resistance, including multidrug resistance. Examples of multidrug-resistant bacteria are methicillin-resistant S. aureus (MRSA) and extended spectrum β-lactamase (ESBL)-producing Gram-negative bacteria.17 The prevalence of MRSA infection in Asian countries is notably high (>50%), particularly in Iran, which has a prevalence of 84.6%.18,19 In addition, Vellappally et al.20 reported the prevalence of MRSA as 65.3%. The prevalence of ESBL is also high, with Endriani et al.17 reporting positive ESBL-producing E. coli in 33.33% of cases. Patients with surgical site infections were found to have positive ESBL-producing bacteria, such as E. coli (55%), Klebsiella sp. (33.1%), and Proteus sp./Pseudomonas sp. (11.1%).21 Silk is a commonly used type of suture among surgeons due to its better tensile strength and ease of application and knotting. Nevertheless, silk sutures possess a higher risk of bacterial colonization that could lead to an increased risk of infection and the need for antibiotic administration.14 This study aims to identify bacterial profiles and antibiotic sensitivity patterns in patients undergoing odontectomy with the use of silk sutures. MATERIALS AND METHODS This study was conducted at Arifin Achmad Hospital of Riau, Indonesia, and the Microbiology Laboratory, Faculty of Medicine, University of Riau, between May and November 2021. Data collection was performed at the Oral Surgery Clinic, Arifin Achmad Hospital of Riau, utilizing consecutive sampling. Primary data comprised bacterial identification on silk sutures used in post-odontectomy wounds, and secondary data included patient characteristics, such as gender, age, education, and occupation, obtained from medical records. Ethical clearance for this study was granted by the Faculty of Medicine, University of Riau (Decree number: B/058/ UN19.5.1.1.8/UEPKK/2021_addendum). The tools and materials used in this study included post-odontectomy silk sutures and standard materials for conventional bacterial culture and identification, such as trypticase soy broth (TSB) medium, blood agar plates (BAP), MacConkey agar plates, and various antibiotic disks. The study participants were patients who had undergone odontectomy, who were sutured with silk sutures of the same brand, and who attended initial post-procedural controls. The inclusion criteria encompassed patients who had undergone odontectomy and were attending control visits and suture removal within 14 days after odontectomy and who were willing to participate in the research by signing informed consent forms. The exclusion criteria included patients attending control visits with suture removal after 14 days or had removed the sutures themselves. Oral hygiene (OH) index examinations were not conducted in this study. Silk sutures from patients within 14 days after odontectomy were cut with scissors to approximately 1 cm in length, and one piece of thread was inserted into the TSB medium. The bacteria on the TSB media were then streaked onto BAP and MacConkey agar plates and incubated at 37°C for 18–24 hours. Colonies were identified macroscopically and microscopically using Gram staining. The identification of Gram-positive bacteria involved catalase tests to differentiate staphylococci from Copyright © 2025 Dental Journal (Majalah Kedokteran Gigi) p-ISSN: 1978-3728; e-ISSN: 2442-9740. Accredited No. 158/E/KPT/2021. Open access under CC-BY-SA license. Available at https://e-journal.unair.ac.id/MKG/index DOI: 10.20473/j.djmkg.v58.i2.p128–134 https://e-journal.unair.ac.id/MKG/index https://doi.org/10.20473/j.djmkg.v58.i2.p128-134 130 Endriani et al. Dent. J. (Majalah Kedokteran Gigi) 2025 June; 58(2): 128–134 streptococci, coagulase tests, and novobiocin tests to distinguish S. aureus from CNS, the two types of bacteria that are the most commonly identified in infections in the oral cavity. Gram-negative bacteria were identified through biochemical reaction tests, including triple sugar iron agar, hydrogen sulfide, carbon dioxide, indole, citrate, and motility tests. Bacteria were then tested for antibiotic sensitivity using the disc diffusion/Kirby–Bauer method. Clear zones or inhibition zones around the antibiotic discs were measured with calipers in millimeters (mm) and interpreted according to the Clinical and Laboratory Standards Institute criteria according to the type of bacteria and type of antibiotic, with the results classified as sensitive or resistant. The identification of MRSA was performed by testing the sensitivity of S. aureus using a 30-µg cefoxitin antibiotic disc (resistant if the diameter is ≤21mm). To identify ESBL strains, this study used presumptive and confirmative tests. The presumptive test used the antibiotic ceftazidime with a clear zone of resistance (clear zone diameter ≤20 mm), and the confirmative test used ceftazidime, cefotaxime, and amoxicillin clavulanate with a clear zone of resistance (clear zone diameter difference ≥5 mm).22 Data were recorded and presented as percentages in frequency distribution tables. RESULTS The present study involved 33 patients undergoing odontectomy using silk sutures. Table 1 summarizes the characteristics of the study participants. The identification of Gram bacteria was based on culture and Gram-staining results. Gram-positive cocci bacteria yielded positive catalase (staphylococci) and negative catalase (streptococci) test results. Positive coagulase tests indicated S. aureus, whereas negative coagulase tests indicated CNS. Furthermore, novobiocin sensitive tests indicated S. aureus, and novobiocin resistant tests indicated CNS. The results of the biochemical reaction test for Gram- negative bacilli are summarized in Table 2. All the collected silk suture samples exhibited bacterial growth (100%) identified as bacterial colonies. A total of 54 types of bacteria were identified from the samples, with some plates showing bacterial growth of more than one type. Based on the identification of the bacterial colonies (Figure 1), the bacterial patterns are listed in Table 3. Table 1. Characteristics of the study participants Parameter N (%) Gender Male 12 (36.4) Female 21 (63.6) Age group (years) <20 years 9 (27.3) 20–25 years 9 (27.3) 26–30 years 7 (21.2) >30 years 8 (24.2) Highest level of education Elementary school 0 (0) Junior high School 3 (9.1) Senior high School 23 (69.7) College/University 7 (21.2) Occupation Student 18 (54.5) Employed/Retired 1 (3) Private employee/self-employed 10 (30.3) Farmer/fisher 1 (3) Homemaker 3 (9.2) Table 2. Results of the biochemical reaction tests for Gram-negative bacilli Bacteria TSIA H2S CO2 Indole Citrate Motility Escherichia coli A/A − + − − + Klebsiella sp. A/A − + − + − Pseudomonas sp. K/K + + − + + Proteus sp. K/A + − − + Enterobacter sp. A/A − − − + + A B Figure 1. Bacterial colonies (A), and sensitivity test results (B). Copyright © 2025 Dental Journal (Majalah Kedokteran Gigi) p-ISSN: 1978-3728; e-ISSN: 2442-9740. Accredited No. 158/E/KPT/2021. Open access under CC-BY-SA license. Available at https://e-journal.unair.ac.id/MKG/index DOI: 10.20473/j.djmkg.v58.i2.p128–134 https://e-journal.unair.ac.id/MKG/index https://doi.org/10.20473/j.djmkg.v58.i2.p128-134 131Endriani et al. Dent. J. (Majalah Kedokteran Gigi) 2025 June; 58(2): 128–134 E.coli, Proteus sp., Klebsiella sp., and Pseudomonas sp.) isolated from the silk sutures. The Gram-negative bacteria were highly sensitive to ceftazidime (92%), levofloxacin (92%), and meropenem (92%), with the highest resistance found for ampicillin (88%). From the seven colonies of S. aureus detected, four (57.1%) were identified as MRSA. However, ESBL was not detected after the antibiotic sensitivity test. DISCUSSION In the present study, odontectomy was most prevalent in women (63.6%), aged <20 and 20–25 years (27.3%), with senior high school as the highest education level achieved (69.7%), and who were students (54.5%) (Table 1). Similarly, Rizqiawan et al.23 reported that out of 916 patients undergoing odontectomy, 59% were women and 41% men. The higher prevalence of women undergoing odontectomy is associated with an earlier halt in physical growth. Jaw growth in women stops after the third molar has erupted, whereas growth continues in men even after the third molar has erupted. This phenomenon results in a smaller jaw size in women.24 Busra et al.25 reported that out of 545 patients undergoing odontectomy, 179 Table 3. Bacterial pattern on silk sutures used in odontectomy Bacteria N (%) Streptococcus sp. 18 (33.3) Coagulase-negative staphylococci 4 (7.4) Staphylococcus aureus 7 (13) Total Gram positive 29 (53.7) Enterobacter sp. 11 (20.4) Escherichia coli 1 (1.8) Proteus sp. 1 (1.8) Klebsiella sp. 9 (16.7) Pseudomonas sp. 3 (5.6) Total Gram negative 25 (46.3) 20.7 93.1 58.6 75.9 86.2 72.4 86.2 62.1 3.4 24.1 37.9 27.6 79.3 6.9 41.4 24.1 13.8 27.6 13.8 37.9 96.6 75.9 62.1 72.4 0 20 40 60 80 100 120 Susceptible (%) Non Susceptible (%) Figure 2. Antibiotic sensitivity pattern for all Gram-positive bacteria (n = 29). 12 92 92 72 76 72 76 9288 8 8 28 24 28 24 8 0 10 20 30 40 50 60 70 80 90 100 Susceptible (%) Non Susceptible (%) Figure 2 presents the antibiotic sensitivity pattern for all the Gram-positive bacteria (Streptococcus sp., S. aureus, and CNS) isolated from the silk sutures. The Gram- positive bacteria were highly sensitive to levofloxacin (93.1%), gentamicin (86.2%), and meropenem (86.2%). The highest resistance was determined for metronidazole (96.6%), followed by ampicillin (79.3% ), ciprofloxacin, and clindamycin (75.9%). Figure 3 presents the antibiotic sensitivity pattern for all the Gram-negative bacteria (Enterobacter sp., Figure 3. Antibiotic sensitivity pattern for all Gram-negative bacteria (n = 25). Copyright © 2025 Dental Journal (Majalah Kedokteran Gigi) p-ISSN: 1978-3728; e-ISSN: 2442-9740. Accredited No. 158/E/KPT/2021. Open access under CC-BY-SA license. Available at https://e-journal.unair.ac.id/MKG/index DOI: 10.20473/j.djmkg.v58.i2.p128–134 https://e-journal.unair.ac.id/MKG/index https://doi.org/10.20473/j.djmkg.v58.i2.p128-134 132 Endriani et al. Dent. J. (Majalah Kedokteran Gigi) 2025 June; 58(2): 128–134 (32.8%) were aged 20–25 years. This is likely caused by particular eating habits, the intensity of mastication, and genetic factors.26 The bacteria present in the silk sutures used in odontectomy are mostly Gram-positive bacteria (Table 3), such as Streptococcus sp. and S. aureus, whereas the Gram-negative bacteria found include Enterobacter sp. and Klebsiella sp. Barasa et al.15 reported that the most common bacteria causing infection in the oral cavity after surgery are S. aureus among the Gram-positive bacteria and Klebsiella sp., Pseudomonas sp., Proteus mirabilis, and E. coli among the Gram-negative bacteria. Endriani et al.6 stated that the most common bacteria isolated from odontectomy wounds are Gram-positive and include alpha- hemolytic streptococci, S. aureus, and CNS. Moreover, the commonly isolated Gram-negative bacteria are Klebsiella sp., Enterobacter sp., and Pseudomonas sp. Similarly, Nadafpour et al.27 identified E. coli, S. aureus, streptococcus mutants, and E. faecalis among the bacteria colonizing silk sutures. The large number of Gram- positive bacteria identified from the oral cavity is because Gram-positive bacteria have adhesins that are associated with cell walls and can bind to collagen and fibronectin proteins. The cell wall of Gram-positive bacteria consists of thick, unchanging peptidoglycans and teichoic acid glycopolymers, which influence the colonization of Gram- positive bacteria to form biofilms that influence antibiotic resistance, whereas Gram-negative bacteria have thin peptidoglycans and lipolysaccharides.28 The difference in the isolated bacteria is probably caused by an imbalance in the oral cavity ecosystem as a result of medical treatment, biological and pH changes, and poor OH, which could lead to opportunistic infections.29 Streptococci can assimilate large amounts of carbohydrates via glycolysis and increase their tolerance to acidic pH. Streptococcus sp., as the most dominant bacteria of the oral cavity, possesses several high affinity adhesins that mediate the initial attachment of bacteria to the tooth surface through interactions with salivary substrates, such as albumin, proline, glycoproteins, and mucin. Macromolecules and amylase affect the colonization of streptococcus bacteria in the mouth.30 Enterobacter sp. and Klebsiella sp., including Enterobacteriaceae, are also commonly found in oral cavity infections. Enterobacteriaceae can spread through saliva, which could worsen a person’s health, particularly in patients who are immunocompromised. In these patients, infections can be more severe and develop into systemic infections.31,32 This study found that Gram-positive bacteria in silk sutures used following odontectomy exhibit the highest sensitivity to levofloxacin (93.1%), followed by gentamicin (86.2%) and meropenem (86.2%), as shown in Figure 2. The results of this study revealed that S. aureus was sensitive to levofloxacin, gentamicin, and meropenem (100%), Streptococcus sp. was sensitive to levofloxacin (94.4%), and CNS was sensitive to levofloxacin, ciprofloxacin, gentamicin, chloramphenicol, and meropenem (75%). This study also found that Gram-negative bacteria were most sensitive to levofloxacin, ceftazidime, and meropenem (92%), as shown in Figure 3. Several other studies similar to ours have also reported that Gram-positive and Gram-negative bacteria generally have high sensitivity to levofloxacin, meropenem, and gentamicin.6,15,33–38 Endriani et al.6 and Barasa et al.15 reported that S. aureus was sensitive to cefotaxime, whereas Klebsiella sp. showed the highest sensitivity to meropenem, followed by levofloxacin and gentamicin. Proteus mirabilis has a high sensitivity to meropenem and levofloxacin. Mwangi33 reported that aerobic bacteria exhibit sensitivity to levofloxacin, meropenem, and amikacin. Mohseni et al.34 reported that fluoroquinolone antibiotics, such as levofloxacin and ciprofloxacin, are effective for Enterobacter sp. bacteria. Enitan et al.35 reported that Enterobacter spp. bacteria are most sensitive to levofloxacin. Mustikaningtyas et al.36 and Rijal and Romdhoni37 reported the sensitivity of Gram- negative bacteria to meropenem and levofloxacin. Putra et al.38 reported that both Gram-negative and Gram-positive bacteria are sensitive to meropenem and levofloxacin. Levofloxacin belongs to the fluoroquinolone group, a bactericidal antibiotic that directly inhibits topoisomerase IV, DNA gyrase, and bacterial DNA synthesis. Levofloxacin promotes DNA strand damage by inhibiting DNA gyrase, an enzyme required for DNA replication, transcription, repair, and recombination in susceptible organisms. This bactericidal antibiotic also demonstrates in vitro activity against a wide range of Gram-positive and Gram-negative microorganisms. In Gram-positive microorganisms, fluoroquinolone works by inhibiting topoisomerase II and IV in bacteria. Topoisomerase II enzymes relax DNA while it is experiencing positive supercooling during DNA replication, whereas topoisomerase IV separates newly formed bacterial DNA.38 In Gram-negative bacteria, the main target of fluoroquinolone is DNA gyrase. Fluoroquinolone can even bind to secondary targets, which is helpful if the main target has undergone a mutation.39 In the present study, MRSA was found in the sample (57.1%). Similar to this finding, Endriani et al.6 and McCormack et al.40 reported MRSA being isolated from oral cavity samples (33% and 10%, respectively). Al-Akwa et al.41 stated that out of 115 isolates of S. aureus, 23.5% were MRSA bacteria. The resistance of MRSA to various antibiotics is divided into β-lactam and non-β-lactam antibiotic resistance. The resistance of β-lactam antibiotics is caused by a mutation that converts penicillin-binding protein (PBP)-2 to PBP2a. The function of PBP2, which is inhibited by β- lactam, is compensated by PBP2a so that transpeptidase activity cannot be inhibited and cell wall synthesis in MRSA bacteria continues to occur. This mutation is caused by the insertion of several nucleotide bases from the substituted β-lactamase operon gene in the PBP2-forming gene called the mec gene. The resistance of MRSA that does not occur Copyright © 2025 Dental Journal (Majalah Kedokteran Gigi) p-ISSN: 1978-3728; e-ISSN: 2442-9740. Accredited No. 158/E/KPT/2021. Open access under CC-BY-SA license. Available at https://e-journal.unair.ac.id/MKG/index DOI: 10.20473/j.djmkg.v58.i2.p128–134 https://e-journal.unair.ac.id/MKG/index https://doi.org/10.20473/j.djmkg.v58.i2.p128-134 133Endriani et al. Dent. J. (Majalah Kedokteran Gigi) 2025 June; 58(2): 128–134 in β-lactam antibiotics is mainly caused by changes in antibiotic receptors that are actively pumped from cells, better known as the efflux mechanism.42 In this study, negative results indicated the absence of the ESBL strain in the oral cavity. This result aligns with a study conducted by Søraas et al.43 on supragingival plaque cultures, which also found no ESBLs. Patients who are at risk of being infected with ESBL- producing bacteria are often those who are in the intensive care unit and who have a long hospital stay, whereas the participants in this study were patients in outpatient care. Differences in the prevalence of antibiotic-resistant bacteria could be multifactorial, including the irrational use of antibiotics, the severity of the disease, different types of samples, and the methods used, which can produce variations in research results.17 Odontectomy, which includes minor surgery, can cause various complications. Ali44 reported that the most frequently reported complications were pain (40.9%), alveolar osteitis (27.3%), and infection (11.4%). Antibiotics could be given as pharmacological therapy for the infection.45 Antibiotic administration should always follow the principles and protocols of drug use; thus, they should be appropriate, safe, and rational. The irrational use of antibiotics over a long period increases the resistance of bacteria to antibiotics and even gives rise to multidrug- resistant strains. Clinicians require greater awareness of the increase in antibiotic-resistant and multidrug-resistant bacteria, and research is needed to provide guidelines for antibiotic therapy, especially after odontectomy.46 The limitations of this study are not knowing whether the patient was free of antibiotics or prophylactic antibiotics had been administered to the patient before odontectomy, not assessing the patient’s OH index and periodontal condition in relation to bacteria prevalence, and the limited number of samples obtained from patients undergoing odontectomy in a limited time; therefore, more samples are needed to be able to describe the actual bacterial pattern and antibacterial sensitivity. It is also necessary to consider administering prophylactic antibiotics to reduce the risk of post-odontectomy infection. In conclusion, the most dominant bacteria isolated from the silk sutures following odontectomy are Streptococcus sp., S. aureus, and MRSA for Gram-positive bacteria and Enterobacter sp. and Klebsiella sp. for Gram- negative bacteria. The most effective antibiotics used after odontectomy are levofloxacin, ceftazidime, and meropenem. ACKNOWLEDGEMENTS This study was supported by University of Riau, Indonesia. We would like to show our gratitude to our colleagues in the Microbiology Department, University of Riau who provided insight and expertise that greatly assisted this study. REFERENCES 1. Al-Ramil AM, Al-Wosaibi AM, Bukhary MT. Prevalence of impacted teeth and associated pathologies: A radiographic study, Al Ahsa, Saudi Arabia Population. Egypt J Hosp Med. 2018; 70(12): 2130–6. 2. Al-Shamahy HA. Prevalence and pattern of third molar impaction in sample of Yemeni adults. Online J Dent Oral Heal. 2019; 1(5): 1–4. 3. Al-Mayali AMY, Nahidh M, Alnajar HA, Fahad AH. Impaction prevalence of permanent teeth pattern from orthodontic view. EurAsian J Biosci. 2020; 14(2): 2823–8. 4. Lita YA, Hadikrishna I. Klasifikasi impaksi gigi molar ketiga melalui pemeriksaan radiografi sebagai penunjang odontektomi. J Radiol Dentomaksilofasial Indones. 2020; 4(1): 1–5. 5. Fahira A, Hadikrishna I, Riawan L, Lita YA. Characteristics of upper third molar impaction in Bandung City population. ODONTO Dent J. 2022; 9(1): 57–68. 6. Endriani R, Rafni E, Prakoso A, Hadi F, Adina Dwideta V, Dwi Alni A. Aerobic bacteria and antibiotic sensitivity on odontectomy wound in RSUD Arifin Achmad Riau. Int J Sci Res Dent Med Sci. 2022; 4: 26–32. 7. Gunardi OJ, Danudiningrat CP, Rizqiawan A, Mulyawan I, Amir MS, Kamadjaja DB, Sumarta NPM, Anugraha G, Fessi R Al, Barus L, Ono S. Decision-making criteria of odontectomy or surgical exposure in impacted maxillary canine based on treatment difficulty index modification. Eur J Dent. 2022; 16(4): 796–802. 8. Dewi AWK, Kusumaputra BH, Listiawan MY, Sari M, Citrashanty I. Wound closure technique. J Pakistan Assoc Dermatologists. 2023; 33(2): 655–63. 9. Bucci M, Borgonovo A, Bianchi A, Zanellato A, Re D. Microbiological analysis of bacterial plaque on three different threads in oral surgery. Minerva Stomatol. 2017; 66(1): 28–34. 10. Faris A, Khalid L, Hashim M, Yaghi S, Magde T, Bouresly W, Hamdoon Z, Uthman AT, Marei H, Al-Rawi N. Characteristics of Suture Materials Used in Oral Surgery: Systematic Review. Int Dent J. 2022; 72(3): 278–87. 11. Scarano A, Inchingolo F, Leo L, Buggea C, Crisante A, Greco Lucchina A, Scogna G. Bacterial adherence to silk and expanded polytatrafluorethilene sutures: an in vivo human study. J Biol Regul Homeost Agents. 2021; 35(2 Suppl. 1): 205–10. 12. Sitorus MG. Perbandingan waktu penyembuhan luka pasca odontektomi dengan menggunakan benang silk dan catgut di Rumah Sakit Umum Daerah Pirngadi Medan. Universitas Sumatera Utara; 2018. p. 2–3. 13. de Castro Costa Neto O, Lobo LA, Iorio NLP, de Fátima Carvalho Vasconcelos M, Maia LC, Tannure PN, Antonio AG. Oral bacteria adherence to suture threads: an in vitro study. Oral Maxillofac Surg. 2015; 19(3): 275–80. 14. Syaflida R, Hanafiah OA, Riza A, Rifqi Fauzie M. Comparison of bacterial colonies adherence on silk and catgut sutures in odontectomy patient at Dr. Pirngadi Hospital. J Dentomaxillofacial Sci. 2021; 6(3): 175–9. 15. Barasa GB, Butt F, Onyango JF, Mutua FM, Dimba E. Antibiotic sensitivity patterns of aerobic bacterial agents in post- surgical orofacial infections. Ann African Surg. 2015; 12(1): 32–7. 16. Kamiński B, Błochowiak K, Kołomański K, Sikora M, Karwan S, Chlubek D. Oral and maxillofacial infections—A bacterial and clinical cross-section. J Clin Med. 2022; 11(10): 2731. 17. Endriani R, Rafni E, Sembiring LP, Siregar FM, Haryadi B, Kurniawan A. Antibiotics multi-resistant bacteria in patient with dental abscess at arifin achmad general hospital of Riau province. In: AIP Conference Proceedings. 2019. p. 020015. 18. Fitria A, Widiasi DE, Airlangga H. Systematic literature review: Prevalensi methicillin-resistant Staphylococcus aureus (MRSA) terhadap infeksi nosokomial di beberapa negara Asia. J Kedokt Komunitas. 2021; 9(1): 1–8. 19. Lee AS, de Lencastre H, Garau J, Kluytmans J, Malhotra-Kumar S, Peschel A, Harbarth S. Methicillin-resistant Staphylococcus aureus. Nat Rev Dis Prim. 2018; 4(1): 18033. Copyright © 2025 Dental Journal (Majalah Kedokteran Gigi) p-ISSN: 1978-3728; e-ISSN: 2442-9740. Accredited No. 158/E/KPT/2021. Open access under CC-BY-SA license. Available at https://e-journal.unair.ac.id/MKG/index DOI: 10.20473/j.djmkg.v58.i2.p128–134 https://e-journal.unair.ac.id/MKG/index https://doi.org/10.20473/j.djmkg.v58.i2.p128-134 134 Endriani et al. Dent. J. (Majalah Kedokteran Gigi) 2025 June; 58(2): 128–134 20. Vellappally S, Divakar DD, Al Kheraif AA, Ramakrishnaiah R, Alqahtani A, Dalati MHN, Anil S, Khan AA, Harikrishna Varma PR. Occurrence of vancomycin-resistant Staphylococcus aureus in the oral cavity of patients with dental caries. Acta Microbiol Immunol Hung. 2017; 64(3): 343–51. 21. Islam MS, Yusuf MA, Islam MB, Jahan WA. Frequency of ESBL in surgical site infection at a Tertiary Care Hospital. J Curr Adv Med Res. 2014; 1(2): 25–9. 22. CLSI. Performance standards for antimicrobial susceptibility testing. 30th ed. CLSI supplement M100. Wayne, PA: Clinical and Laboratory Standards Institute; 2020. 23. Rizqiawan A, Lesmaya YD, Rasyida AZ, Amir MS, Ono S, Kamadjaja DB. Postoperative complications of impacted mandibular third molar extraction related to patient’s age and surgical difficulty level: A cross-sectional retrospective study. Leite Cavalcanti A, editor. Int J Dent. 2022; 2022: 1–6. 24. Šečić S, Prohić S, Komšić S, Vuković A. Incidence of impacted mandibular third molars in population of Bosnia and Herzegovina: a retrospective radiographic study. J Heal Sci. 2013; 3(2): 151–8. 25. Busra DN, Karasutisna T, Yuza AT. Complication occurs after odontectomy of mandibular third molar. Padjadjaran J Dent. 2012; 24(2): 141–7. 26. Rahayu S. Odontektomi, tatalaksana gigi bungsu impaksi. E-Journal WIDYA Kesehat dan Lingkung. 2014; 1(2): 81–9. 27. Nadafpour N, Montazeri M, Moradi M, Ahmadzadeh S, Etemadi A. Bacterial colonization on different suture materials used in oral implantology: A randomized clinical trial. Front Dent. 2021; 18: 1–7. 28. Ruhal R, Kataria R. Biofilm patterns in gram-positive and gram- negative bacteria. Microbiol Res. 2021; 251: 126829. 29. Zaatout N. Presence of non-oral bacteria in the oral cavity. Arch Microbiol. 2021; 203(6): 2747–60. 30. Abranches J, Zeng L, Kajfasz JK, Palmer SR, Chakraborty B, Wen ZT, Richards VP, Brady LJ, Lemos JA. Biology of oral streptococci. Fischetti VA, Novick RP, Ferretti JJ, Portnoy DA, Braunstein M, Rood JI, editors. Microbiol Spectr. 2018; 6(5). 31. Leão-Vasconcelos LSN de O, Lima ABM, Costa D de M, Rocha- Vilefort LO, de Oliveira ACA, Gonçalves NF, Vieira JDG, Prado- Palos MA. Enterobacteriaceae isolates from the oral cavity of workers in a Brazilian oncology hospital. Rev Inst Med Trop Sao Paulo. 2015; 57(2): 121–7. 32. Kitamoto S, Nagao-Kitamoto H, Jiao Y, Gillilland MG, Hayashi A, Imai J, Sugihara K, Miyoshi M, Brazil JC, Kuffa P, Hill BD, Rizvi SM, Wen F, Bishu S, Inohara N, Eaton KA, Nusrat A, Lei YL, Giannobile W V, Kamada N. The intermucosal connection between the mouth and gut in commensal pathobiont-driven colitis. Cell. 2020; 182(2): 447-462.e14. 33. Mwangi JG. Pattern of orofacial infective bacterial microorganisms and their antibiogram profiles at Kenyatta National Hospital. University of Nairobi; 2019. 34. Mohseni Afshar Z, Miladi R, Janbakhsh A, Mansouri F, Sayad B, Vaziri S, Afsharian M, Zamanian MH, Shirvani M, Yavari S, Tarlan M, Khazaei S. The prevalence and pattern of enterobacter antibiotic resistance in the patients admitted to Imam Reza Hospital in Kermanshah, Iran (2016 - 2018). J Kermanshah Univ Med Sci. 2021; 25(1): 1–6. 35. Enitan SS, Oluremi AS, Ochei JO, Akele RY, Usiobeigbe SO, Emmanuel I, Enitan CB, Tajudeen RO. Assessment of oral bacterial profile and antibiogram of patients attending Dental Clinic of a Private Tertiary Hospital in Ogun State, Nigeria. Saudi J Oral Dent Res. 2020; 5(1): 11–23. 36. Mustikaningtyas MH, Semedi BP, Kuntaman K. Bacterial and sensitivity pattern of pathogens causing Ventilator-Associated Pneumonia in Intensive Care Unit. Maj Biomorfologi. 2022; 32(1): 22. 37. Rijal S, Romdhoni AC. Bacteria pattern, results of antibiotic sensitivity test, and complications of deep neck abscess patients in Dr. Soetomo General Hospital. Biomol Heal Sci J. 2018; 1(2): 124. 38. Putra IW, Setyaningtyas A, Puspitasari D, Irwanto I, Wahyu AD, Dharmawati I, Azis AL, Kuntaman K. Microbial pattern and antibiotic susceptibility in Pediatric Intensive Care Unit Dr. Soetomo Hospital, Surabaya. Indones J Trop Infect Dis. 2019; 7(5): 122–30. 39. Gunawan SG, Setiabudy R, Nafrialdi, Instiaty. Farmakologi dan terapi. 6th ed. Jakarta: Badan Penerbit FKUI; 2019. p. 932. 40. McCormack MG, Smith AJ, Akram AN, Jackson M, Robertson D, Edwards G. Staphylococcus aureus and the oral cavity: An overlooked source of carriage and infection? Am J Infect Control. 2015; 43(1): 35–7. 41. Al-Akwa AAY, Zabara AQMQ, Al-Shamahy HA, Al-labani MA, Al-Ghaffari KM, Al-Mortada AM, Al-Haddad AM, Al-Sharani AA. Prevalence of Staphylococcus aureus in dental infections and the occurrence of MRSA in isolates. Univers J Pharm Res. 2020; 5(2): 23–7. 42. Purwoningsih E, Endraswari PD, Widodo ADW. Vancomycin, Linezolid, and Ceftaroline in vitro activity against Methicillin susceptible Staphylococcus aureus (MSSA) and Methicillin-resistant Staphylococcus aureus (MRSA) isolates. Pharmacogn J. 2022; 14(5): 671–4. 43. Søraas A, Olsen I, Sundsfjord A, Handal T, Bjørang O, Jenum PA. Extended-spectrum beta-lactamase-producing bacteria are not detected in supragingival plaque samples from human fecal carriers of ESBL-producing Enterobacteriaceae. J Oral Microbiol. 2014; 6(1): 24026. 44. Ali D. Risk factors of complications subsequent third molar extractions: A prospective cohort study. Brazilian Dent Sci. 2021; 24(4): 2759. 45. Purba AKR, Setiawan D, Bathoorn E, Postma MJ, Dik J-WH, Friedrich AW. Prevention of surgical site infections: a systematic review of cost analyses in the use of prophylactic antibiotics. Front Pharmacol. 2018; 9: 776. 46. Tariq K, Hassan M, Wajahat M, Muneer N, Imran E. Awareness of antibiotic use and antibiotic resistance amongst dental students. Brazilian Dent Sci. 2021; 24(3): 2470. Copyright © 2025 Dental Journal (Majalah Kedokteran Gigi) p-ISSN: 1978-3728; e-ISSN: 2442-9740. Accredited No. 158/E/KPT/2021. Open access under CC-BY-SA license. Available at https://e-journal.unair.ac.id/MKG/index DOI: 10.20473/j.djmkg.v58.i2.p128–134 https://e-journal.unair.ac.id/MKG/index https://doi.org/10.20473/j.djmkg.v58.i2.p128-134