异基因造血细胞移植后的口腔健康状况与菌血症风险
Oral health status and risk of bacteremia following allogeneic hematopoietic cell transplantation.
作者信息
Sultan Ahmed S, Zimering Yvette, Petruzziello Gloria, Alyea Edwin P, Antin Joseph H, Soiffer Robert J, Ho Vincent T, Sonis Stephen T, Woo Sook-Bin, Marty Francisco M, Treister Nathaniel S
机构信息
Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA; Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA.
Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA; Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA.
出版信息
Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Sep;124(3):253-260. doi: 10.1016/j.oooo.2017.06.003. Epub 2017 Jun 16.
OBJECTIVES
The aim of this study was to evaluate the impact of oral health status on bacteremia risk in a cohort of patients with acute myeloid leukemia (AML) who underwent chemotherapy followed by myeloablative allogeneic hematopoietic cell transplantation (allo-HCT).
STUDY DESIGN
A retrospective study was conducted in patients with AML from 2007 to 2011. Oral health status was determined from a pre-allo-HCT dental evaluation. Positive blood cultures were recorded from AML induction to post-allo-HCT day +60. Organisms that caused bacteremia were classified as "of possible oral source" by a blinded microbiologist. Two-sided Fisher's exact test was used to compare the oral health status of the entire cohort with that of patients with blood cultures of potential oral source.
RESULTS
Pre-allo-HCT dental evaluations were completed in 91 (99%) of 92 patients. Of these 91 patients, 13 (14%) with dental pathology (13 of 13 [100%]) completed all required dental treatment before allo-HCT. Bacteremias occurred in 63 of 92 patients (68%), and 12 (19%) of 63 patients had positive blood cultures of potential oral source. Of these, 1 of 12 patients developed bacteremia during AML induction, and 11 of 12 developed bacteremia during allo-HCT.
CONCLUSIONS
Oral health status was not associated with risk of bacteremia of potential oral source either at AML induction or consolidation or at allo-HCT.
目的
本研究旨在评估急性髓系白血病（AML）患者队列中口腔健康状况对菌血症风险的影响，这些患者接受化疗后进行清髓性异基因造血细胞移植（allo-HCT）。
研究设计
对2007年至2011年的AML患者进行了一项回顾性研究。口腔健康状况通过allo-HCT前的牙科评估确定。记录从AML诱导期到allo-HCT后第60天的血培养阳性情况。由一位盲法微生物学家将导致菌血症的微生物分类为“可能源自口腔”。使用双侧Fisher精确检验比较整个队列的口腔健康状况与血培养可能源自口腔的患者的口腔健康状况。
结果
92例患者中的91例（99%）完成了allo-HCT前的牙科评估。在这91例患者中，13例（14%）有牙科病变的患者（13例中的13例[100%]）在allo-HCT前完成了所有所需的牙科治疗。92例患者中有63例（68%）发生了菌血症，63例患者中有12例（19%）血培养可能源自口腔呈阳性。其中，12例患者中有1例在AML诱导期发生菌血症，12例中有11例在allo-HCT期间发生菌血症。
结论
无论是在AML诱导期、巩固期还是allo-HCT时，口腔健康状况与可能源自口腔的菌血症风险均无关联。
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