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Supportive Care in Cancer
Published in: Supportive Care in Cancer 6/2013

01-06-2013 | Original Article

Periodontal status and bacteremia with oral viridans streptococci and coagulase negative staphylococci in allogeneic hematopoietic stem cell transplantation recipients: a prospective observational study

Authors: Judith E. Raber-Durlacher, Alexa M. G. A. Laheij, Joel B. Epstein, Matthew Epstein, Gerard M. Geerligs, Gordon N. Wolffe, Nicole M. A. Blijlevens, J. Peter Donnelly

Published in: Supportive Care in Cancer | Issue 6/2013

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Abstract

Aim

This study was aimed to investigate whether any association could be found between the presence of an inflamed and infected periodontium (e.g., gingivitis and periodontitis) and the development of bacteremia during neutropenia following allogeneic hematopoietic stem cell transplantation (HSCT).

Methods

Eighteen patients underwent a periodontal examination before HSCT. Patients were classified as periodontally healthy [all periodontal pocket depths (PPD) ≤ 4 mm and bleeding on probing (BOP) ≤ 10 %) or as having gingivitis/periodontitis (PPD ≥ 4 mm and BOP > 10 %]. Oral mucositis (OM) was scored using the daily mucositis score. Blood cultures were taken at least twice weekly.

Results

Five patients were periodontally healthy, while 13 patients had gingivitis or periodontitis. Twelve patients (67 %) developed bacteremia during neutropenia, of which 11 patients (61 %) had one or more episodes of bacteremia due to coagulase-negative staphylococci (CONS, most often Staphylococcus epidermidis) or to oral viridans streptococci (OVS), or both. Patients with gingivitis/periodontitis more often had bacteremia than those with a healthy periodontium (p = 0.047), and BOP was associated with bacteremia (p = 0.049). All patients developed ulcerative OM, but its severity and duration were not associated with bacteremia. OM duration and the length of stay in the hospital were strongly correlated (R = 0.835, p ≤ 0.001).

Conclusion

This study indicates that periodontal infections may contribute to the risk of developing OVS and CONS bacteremia during neutropenia following HSCT. While our results point to the importance of periodontal evaluation and management before HSCT, further studies on periodontal contribution to systemic infectious complications are warranted.
Literature
1.
Oliver RC, Brown LJ, Loe H (1998) Periodontal diseases in the United States population. J Periodontol 69:269–278PubMedCrossRef
2.
3.
Slots J, Rams TE (1991) New views on periodontal microbiota in special patient categories. J Clin Periodontol 18:411–420PubMedCrossRef
4.
Michaud DS, Liu Y, Meyer M, Giovannucci E, Joshipura K (2008) Periodontal disease, tooth loss, and cancer risk in male health professionals: a prospective cohort study. Lancet Oncol 9:550–558PubMedCrossRef
5.
Forner L, Larsen T, Kilian M, Holmstrup P (2006) Incidence of bacteremia after chewing, tooth brushing and scaling in individuals with periodontal inflammation. J Clin Periodontol 33:401–407PubMedCrossRef
6.
Lockhart PB, Brennan MT, Sasser HC, Fox PC, Paster BJ, Bahrani-Mougeot FK (2008) Bacteremia associated with toothbrushing and dental extraction. Circulation 117:3118–3125PubMedCrossRef
7.
Lockhart PB, Brennan MT, Thornhill M, Michalowicz BS, Noll J, Bahrani-Mougeot FK, Sasser HC (2009) Poor oral hygiene as a risk factor for infective endocarditis-related bacteremia. J Am Dent Assoc 140:1238–1244PubMed
8.
Kinane DF, Riggio MP, Walker KF, MacKenzie D, Shearer B (2005) Bacteraemia following periodontal procedures. J Clin Periodontol 32:708–713PubMedCrossRef
9.
Lucas VS, GafanG DS, Roberts GJ (2008) Prevalence, intensity and nature of bacteraemia after toothbrushing. J Dent 36:481–487PubMedCrossRef
10.
Silver JG, Martin AW, McBride BC (1997) Experimental transient bacteraemias in human subjects with varying degrees of plaque accumulation and gingival inflammation. J Clin Periodontol 4:92–99CrossRef
11.
Seymour GJ, Ford PJ, Cullinan MP, Leishman S, Yamazaki K (2007) Relationship between periodontal infections and systemic disease. Clin Microbiol Infect 13(Suppl 4):3–10PubMedCrossRef
12.
Peterson DE, Overholser CD (1981) Increased morbidity associated with oral infection in patients with acute nonlymphocytic leukemia. Oral Surg Oral Med Oral Pathol 51:390–393PubMedCrossRef
13.
Greenberg MS, Cohen SG, McKitrick JA, Cassileth PA (1982) The oral flora as a source of septicemia in patients with acute leukemia. Oral Surg Oral Med Oral Pathol 53:32–36PubMedCrossRef
14.
Epstein JB, Stevenson-Moore P (2001) Periodontal disease and periodontal management in patients with cancer. Oral Oncol 37:613–619PubMedCrossRef
15.
Hemmerle J, Frank RM (1991) Bacterial invasion of periodontal tissues after experimental immunosuppression in rats. J Biol Buccale 19:271–282PubMed
16.
Baquero F, Fernandez J, Dronda F, Erice A, Perez de Oteiza J, Reguera JA, Reig M (1991) Capnophilic and anaerobic bacteremia in neutropenic patients: an oral source. Rev Infect Dis 12(Suppl 2):S157–S160
17.
Bilgrami S, Bergstrom SK, Peterson DE, Hill DR, Dainiak N, Quinn JJ, Ascensao JL (1992) Capnocytophaga bacteremia in a patient with Hodgkin’s disease following bone marrow transplantation: case report and review. Clin Infect Dis 14:1045–1049PubMedCrossRef
18.
Landsaat PM, van der Lelie H, Bongaerts G, Kuijper EJ (1995) Fusobacterium nucleatum, a new invasive pathogen in neutropenic patients? Scand J Infect Dis 27:83–84PubMedCrossRef
19.
Fanourgiakism P, Vekemans M, Georgala A, Daneau D, Vandermies A, Grenier P, Aoun M (2003) Febrile neutropenia and Fusobacterium bacteremia: clinical experience with 13 cases. Support Care Cancer 11:332–335
20.
Terhes G, Piukovics K, Urban E, Nagy E (2011) Four cases of bacteraemia caused by Fusobacterium nucleatum in febrile, neutropenic patients. J Med Microbiol 60:1046–1049PubMedCrossRef
21.
Donnelly JP (2000) Infection in the neutropenic and haematopoietic stem cell transplant recipient. Curr Opin Infect Dis 13:337–342PubMedCrossRef
22.
Ruescher TJ, Sodeifi A, Scrivani SJ, Kaban LB, Sonis ST (1998) The impact of mucositis on alpha-hemolytic streptococcal infection in patients undergoing autologous bone marrow transplantation for hematologic malignancies. Cancer 82:2275–2281PubMedCrossRef
23.
Costa SF, Miceli MH, Anaissie EJ (2004) Mucosa or skin as source of coagulase-negative staphylococcal bacteraemia? Lancet Infect Dis 4:278–286PubMedCrossRef
24.
Soga Y, Maeda Y, Ishimaru F, Tanimoto M, Maeda H, Nishimura F, Takashiba S (2011) Bacterial substitution of coagulase-negative staphylococci for streptococci on the oral mucosa after hematopoietic cell transplantation. Support Care Cancer 19:995–1000PubMedCrossRef
25.
Wahlin YB, Holm AK (1988) Changes in the oral microflora in patients with acute leukemia and related disorders during the period of induction therapy. Oral Surg Oral Med Oral Pathol 65:411–417PubMedCrossRef
26.
Dahlen G, Blomquist S, Carlen A (2009) A retrospective study on the microbiology in patients with oral complaints and oral mucosal lesions. Oral Dis 15:265–272PubMedCrossRef
27.
Murdoch FE, Sammons RL, Chapple IL (2004) Isolation and characterization of subgingival staphylococci from periodontitis patients and controls. Oral Dis 10:155–162PubMedCrossRef
28.
Smith AJ, Jackson MS, Bagg J (2001) The ecology of Staphylococcus species in the oral cavity. J Med Microbiol 50:940–946PubMed
29.
Reynolds MA, Minah GE, Peterson DE, Weikel DS, Williams LT, Overholser CD, DePaola LG, Suzuki JB (1989) Periodontal disease and oral microbial successions during myelosuppressive cancer chemotherapy. J Clin Periodontol 16(3):185–189PubMedCrossRef
30.
Peterson DE, Minah GE, Overholser CD, Suzuki JB, DePaola LG, Stansbury DM, Williams LT, Schimpff SC (1987) Microbiology of acute periodontal infection in myelosuppressed cancer patients. J Clin Oncol 5:1461–1468PubMed
31.
Kennedy HF, Morrison D, Kaufmann ME, Jackson MS, Bagg J, Gibson BE, Gemmell GC, Michie JR (2000) Origins of Staphylococcus epidermidis and Streptococcus oralis causing bacteraemia in a bone marrow transplant patient. J Med Microbiol 49:367–370PubMed
32.
Raber-Durlacher JE, Epstein JB, Raber J, van Dissel JT, van Winkelhoff AJ, Guiot HF, van der Velden U (2002) Periodontal infection in cancer patients treated with high-dose chemotherapy. Support Care Cancer 10:466–473PubMedCrossRef
33.
Silness J, Loe H (1964) Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand 22:121–135PubMedCrossRef
34.
Donnelly JP, Muus P, Schattenberg A, De Witte T, Horrevorts A, DePauw BE (1992) A scheme for daily monitoring of oral mucositis in allogeneic BMT recipients. Bone Marrow Transplant 9:409–413PubMed
35.
van der Meer JT, Thompson J, Valkenburg HA, Michel MF (1992) Epidemiology of bacterial endocarditis in The Netherlands. I. Patient characteristics. Arch Intern Med 152:1863–1868PubMedCrossRef
36.
37.
Yoshinari N, Kameyama Y, Aoyama Y, Nishiyama H, Noguchi T (1994) Effect of long-term methotrexate-induced neutropenia on experimental periodontal lesion in rats. J Periodontal Res 29:393–400PubMedCrossRef
38.
Milstein DM, Bezemer R, Lindeboom JA, Ince C (2009) The acute effects of CMF-based chemotherapy on maxillary periodontal microcirculation. Cancer Chemother Pharmacol 64:1047–1052PubMedCrossRef
39.
Soga Y, Yamasuji Y, Kudo C et al (2009) Febrile neutropenia and periodontitis: lessons from a case periodontal treatment in the intervals between chemotherapy cycles for leukemia reduced febrile neutropenia. Support Care Cancer 17:581–587PubMedCrossRef
40.
Bergmann OJ (1989) Oral infections and fever in immunocompromised patients with haematologic malignancies. Eur J Clin Microbiol Infect Dis 8:207–213PubMedCrossRef
41.
Laine PO, Lindqvist JC, Pyrhonen SO, Strand-Pettinen IM, Teerenhovi LM, Meurman JH (1992) Oral infection as a reason for febrile episodes in lymphoma patients receiving cytostatic drugs. Eur J Cancer B Oral Oncol 28B:103–107PubMedCrossRef
42.
Kashiwazaki H, Matsushita T, Sugita J et al (2012) Professional oral health care reduces oral mucositis and febrile neutropenia in patients treated with allogeneic bone marrow transplantation. Support Care Cancer 20:367–673PubMedCrossRef
43.
van der Velden WJ, Blijlevens NM, Feuth T, Donnelly JP (2009) Febrile mucositis in haematopoietic SCT recipients. Bone Marrow Transplant 43:55–60PubMedCrossRef
44.
Sunde PT, Olsen I, Debelian GJ, Tronstad L (2002) Microbiota of periapical lesions refractory to endodontic therapy. J Endod 28:304–310PubMedCrossRef
45.
Akintoye SO, Brennan MT, Graber CJ, McKinney BE, Rams TE, Barrett AJ, Atkinson JC (2002) A retrospective investigation of advanced periodontal disease as a risk factor for septicemia in hematopoietic stem cell and bone marrow transplant recipients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 94:581–588PubMedCrossRef
46.
Nesse W, Abbas F, van der Ploeg I, Spijkervet FK, Dijkstra PU, Vissink A (2008) Periodontal inflamed surface area: quantifying inflammatory burden. J Clin Periodontol 35:668–673PubMedCrossRef
47.
Elad S, Thierer T, Bitan M, Shapira MY, Meyerowitz C (2008) A decision analysis: the dental management of patients prior to hematology cytotoxic therapy or hematopoietic stem cell transplantation. Oral Oncol 44:37–42PubMedCrossRef
Metadata
Title
Periodontal status and bacteremia with oral viridans streptococci and coagulase negative staphylococci in allogeneic hematopoietic stem cell transplantation recipients: a prospective observational study
Authors
Judith E. Raber-Durlacher
Alexa M. G. A. Laheij
Joel B. Epstein
Matthew Epstein
Gerard M. Geerligs
Gordon N. Wolffe
Nicole M. A. Blijlevens
J. Peter Donnelly
Publication date
01-06-2013
Publisher
Springer-Verlag
Published in
Supportive Care in Cancer / Issue 6/2013
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-012-1706-2

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