Badia Priscila, Andersen Heidi, Haslam David, Nelson Adam S, Pate Abigail R, Golkari Sara, Teusink-Cross Ashley, Flesch Laura, Bedel Ashely, Hickey Victoria, Kramer Kathi, Lane Adam, Davies Stella M, Thikkurissy Sarat, Dandoy Christopher E
Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, Arizona.
Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, Arizona; Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Biol Blood Marrow Transplant. 2020 Sep;26(9):1704-1710. doi: 10.1016/j.bbmt.2020.05.019. Epub 2020 Jun 4.
Bloodstream infections (BSIs) from oral organisms are a significant cause of morbidity and mortality in hematopoietic stem cell transplantation (HSCT) recipients. There are no proven strategies to decrease BSIs from oral organisms. The aim of this study was to evaluate the impact of daily xylitol wipes in improving oral health, decreasing BSI from oral organisms, and modulating the oral microbiome in pediatric HSCT recipients. This was a single-center 1:1 randomized controlled trial in pediatric HSCT recipients age >2 years. Age-matched healthy children were enrolled to compare the oral microbiome. The oral hygiene standard of care (SOC) group continued to receive the standard oral hygiene regimen. The xylitol group received daily oral xylitol wipes (with .7 g xylitol) in addition to the SOC. The intervention started from the beginning of the transplantation chemotherapy regimen and extended to 28 days following transplantation. The primary outcome was oral health at interval time points, and secondary outcomes included BSIs from oral organisms in the first 30 days following transplantation, oral microbiome abundance, and diversity and oral pathogenic organism abundance. The study was closed early due to efficacy after an interim analysis of the first 30 HSCT recipients was performed (SOC group, n = 16; xylitol group, n = 14). The xylitol group had a significantly lower rate of gingivitis at days 7, 14, and 28 following transplantation (P = .031, .0039, and .0005, respectively); oral plaque at days 7 and 14 (P = .045 and .0023, respectively); and oral ulcers >10 mm at day 14 (P = .049) compared with the SOC group. The xylitol group had no BSI from oral organisms compared with the SOC group, which had 4 (P = .04). The xylitol group had significantly lower abundance of potential BSI pathogens, such as Staphylococcus aureus (P = .036), Klebsiella pneumoniae (P = .033), and Streptococcus spp (P = .011) at the day after transplantation compared with the SOC group. Healthy children and young adults had significantly increased oral microbiome diversity compared with all HSCT recipients (P < .001). The addition of xylitol to standard oral care significantly improves oral health, decreases BSI from oral organisms, and decreases the abundance of pathogenic oral organisms in pediatric and young adult HSCT recipients.
口腔微生物引起的血流感染（BSIs）是造血干细胞移植（HSCT）受者发病和死亡的重要原因。目前尚无经证实的策略可减少口腔微生物引起的血流感染。本研究的目的是评估每日使用木糖醇擦拭对改善儿科HSCT受者口腔健康、减少口腔微生物引起的血流感染以及调节口腔微生物群的影响。这是一项针对年龄大于2岁的儿科HSCT受者的单中心1:1随机对照试验。招募年龄匹配的健康儿童以比较口腔微生物群。口腔卫生标准护理（SOC）组继续接受标准口腔卫生方案。木糖醇组除标准护理外，每日使用含0.7 g木糖醇的口腔擦拭巾。干预从移植化疗方案开始时启动，并持续至移植后28天。主要结局是各时间点的口腔健康，次要结局包括移植后前30天内口腔微生物引起的血流感染、口腔微生物群丰度和多样性以及口腔致病微生物丰度。在对前30例HSCT受者（SOC组，n = 16；木糖醇组，n = 14）进行中期分析后，由于疗效显著，该研究提前结束。与SOC组相比，木糖醇组在移植后第7天、14天和28天的牙龈炎发生率显著更低（分别为P = 0.031、0.0039和0.0005）；在第7天和14天的口腔菌斑（分别为P = 0.045和0.0023）；以及在第14天直径>10 mm的口腔溃疡发生率（P = 0.049）。与SOC组相比，木糖醇组未发生口腔微生物引起的血流感染，而SOC组有4例（P = 0.04）。与SOC组相比，木糖醇组在移植后第1天潜在血流感染病原体的丰度显著更低，如金黄色葡萄球菌（P = 0.036）、肺炎克雷伯菌（P = 0.033）和链球菌属（P = 0.011）。与所有HSCT受者相比，健康儿童和年轻成年人的口腔微生物群多样性显著增加（P < 0.001）。在标准口腔护理中添加木糖醇可显著改善儿科和年轻成人HSCT受者的口腔健康，减少口腔微生物引起的血流感染，并降低口腔致病微生物的丰度。
