Usmani Saad, Choquette Linda, Bona Robert, Feinn Richard, Shahid Zainab, Lalla Rajesh V
Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Carolinas Healthcare System, Charlotte, NC, USA.
The Jackson Laboratory, Farmington, CT, USA.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2018 Apr;125(4):286-294. doi: 10.1016/j.oooo.2017.12.022. Epub 2018 Jan 11.
The aim of this study was to determine the incidence of bacteremia resulting from dental cleaning and of subsequent established bloodstream infection (BSI) caused by oral microorganisms in patients with cancer with central venous catheters (CVCs).
Twenty-six patients with cancer with CVCs and absolute neutrophil count over 1000 cells/µL received dental cleaning without antibiotic prophylaxis. Periodontal status was assessed at baseline by using the Periodontal Screening and Recording (PSR) score. Blood cultures were drawn via the CVCs at baseline, 20 minutes into cleaning, and 30 minutes and 24 hours after cleaning. Medical records were monitored for 6 months.
Baseline blood culture results were negative in 25 patients. Nine of 25 patients (36%) had positive blood culture 20 minutes into cleaning, all associated with at least 1 microorganism typically found in the mouth. These 9 patients had significantly higher mean PSR score (3.22) compared with the other 16 (2.56; P = .035). These expected bacteremias did not persist, with blood culture results (0/25) at 30 minutes and 24 hours after cleaning showing no positivity (P = .001). There were no cases of CVC-related infection or BSI attributable to dental cleaning.
Bacteremia resulting from dental cleaning is transient and unlikely to cause CVC-related infection or BSI in patients with absolute neutrophil count greater than 1000 cells/µL.
本研究旨在确定癌症患者中心静脉导管(CVC)进行牙齿清洁后菌血症的发生率,以及后续由口腔微生物引起的确诊血流感染(BSI)的发生率。
26例患有CVC且绝对中性粒细胞计数超过1000个细胞/μL的癌症患者在未进行抗生素预防的情况下接受了牙齿清洁。在基线时使用牙周筛查与记录(PSR)评分评估牙周状况。在基线、清洁开始20分钟、清洁后30分钟和24小时通过CVC采集血培养样本。对病历进行6个月的监测。
25例患者基线血培养结果为阴性。25例患者中有9例(36%)在清洁开始20分钟时血培养呈阳性,所有阳性结果均与至少1种口腔中常见的微生物有关。这9例患者的平均PSR评分(3.22)显著高于其他16例患者(2.56;P = 0.035)。这些预期的菌血症未持续存在,清洁后30分钟和24小时的血培养结果(0/25)均未显示阳性(P = 0.001)。没有因牙齿清洁导致的CVC相关感染或BSI病例。
对于绝对中性粒细胞计数大于1000个细胞/μL的患者,牙齿清洁导致的菌血症是短暂的,不太可能引起CVC相关感染或BSI。