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

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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.

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Disclosures

No disclosures with a potential conflict of interest with the present observational study.

Author information

Authors and Affiliations

  1. Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands

    Judith E. Raber-Durlacher

  2. Department of Oral and Maxillofacial Surgery, Academic Medical Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands

    Judith E. Raber-Durlacher

  3. Department of Preventive Dentistry, ACTA, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands

    Alexa M. G. A. Laheij

  4. Division of Otolaryngology and Head and Neck Surgery, City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA

    Joel B. Epstein

  5. Department of Oral and Maxillofacial Surgery, St. Joseph’s Regional Medical Center, Paterson, NJ, USA

    Matthew Epstein

  6. Ministry of Defence, Royal Netherlands Army, Military Dental Center Amersfoort, Department of Periodontology and Implantology, Amersfoort, The Netherlands

    Gerard M. Geerligs

  7. Hemel Hempstead, UK

    Gordon N. Wolffe

  8. Department of Haematology, University Medical Centre St. Radboud, Nijmegen, The Netherlands

    Nicole M. A. Blijlevens & J. Peter Donnelly

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  1. Judith E. Raber-Durlacher
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Correspondence to Judith E. Raber-Durlacher.

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Raber-Durlacher, J.E., Laheij, A.M.G.A., Epstein, J.B. et al. Periodontal status and bacteremia with oral viridans streptococci and coagulase negative staphylococci in allogeneic hematopoietic stem cell transplantation recipients: a prospective observational study. Support Care Cancer 21, 1621–1627 (2013). https://doi.org/10.1007/s00520-012-1706-2

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  • DOI: https://doi.org/10.1007/s00520-012-1706-2

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