Bajio Regional High Specialty Hospital, San Carlos La Roncha C.P. 37544, Leon Guanajuato, Mexico.
Department of Medicine, University of Guanajuato, San Carlos La Roncha C.P. 37660, Leon Guanajuato, Mexico.
BMC Oral Health. 2023 Jul 8;23(1):465. doi: 10.1186/s12903-023-03172-y.
Colonization of the oropharynx with gram-negative bacilli (GNB) is considered a negative prognostic factor in immunocompromised individuals. Hemato-oncologic patients represent a high-risk group due to their immunodeficiencies and associated treatments. This study aimed to determine the rates of oral colonization by GNB, associated factors, and clinical outcomes in patients with hematologic malignancies and solid tumors compared with healthy subjects.
We conducted a comparative study of hemato-oncologic patients and healthy subjects from August to October 2022. Swabs were taken from the oral cavity; specimens with GNB were identified and tested for antimicrobial susceptibility.
We included 206 participants (103 hemato-oncologic patients and 103 healthy subjects). Hemato-oncologic patients had higher rates of oral colonization by GNB (34% vs. 17%, P = 0.007) and GNB resistant to third-generation cephalosporins (11.6% vs. 0%, P < 0.001) compared to healthy subjects. Klebsiella spp. was the predominant genus in both groups. The factor associated with oral colonization by GNB was a Charlson index ≥ 3, while ≥ 3 dental visits per year were a protective factor. Regarding colonization by resistant GNB in oncology patients, antibiotic therapy and a Charlson index ≥ 5 were identified as associated factors, while better physical functionality (ECOG ≤ 2) was associated with less colonization. Hemato-oncologic patients colonized with GNB had more 30-day infectious complications (30.5% vs. 2.9%, P = 0.0001) than non-colonized patients.
Oral colonization by GNB and resistant GNB are prevalent in cancer patients, especially those with higher scores on the severity scales. Infectious complications occurred more frequently in colonized patients. There is a knowledge gap about dental hygiene practices in hemato-oncologic patients colonized by GNB. Our results suggest that patients' hygienic-dietary habits, especially frequent dental visits, are a protective factor against colonization.
口咽部革兰氏阴性杆菌（GNB）定植被认为是免疫功能低下人群的一个负面预后因素。血液肿瘤患者由于免疫缺陷和相关治疗，属于高风险群体。本研究旨在比较血液系统恶性肿瘤和实体瘤患者与健康受试者之间，GNB 口咽部定植率、相关因素以及临床结局。
我们于 2022 年 8 月至 10 月进行了一项血液系统恶性肿瘤患者与健康受试者的对比研究。从口腔中采集拭子；鉴定并测试 GNB 标本的药敏性。
我们纳入了 206 名参与者（103 名血液系统恶性肿瘤患者和 103 名健康受试者）。与健康受试者相比，血液系统恶性肿瘤患者的 GNB 口咽部定植率更高（34%比 17%，P=0.007），且对第三代头孢菌素耐药的 GNB 比例更高（11.6%比 0%，P<0.001）。两组中最主要的菌属均为克雷伯氏菌属。与 GNB 口咽部定植相关的因素是Charlson 指数≥3，而每年看牙≥3 次是一个保护因素。在肿瘤患者中，与耐药 GNB 定植相关的因素是抗生素治疗和 Charlson 指数≥5，而身体功能状态更好（ECOG≤2）与定植率较低相关。GNB 定植的血液系统恶性肿瘤患者在 30 天内发生感染性并发症的比例（30.5%比 2.9%，P=0.0001）高于未定植患者。
GNB 和耐药 GNB 在癌症患者中普遍定植，尤其是在严重程度评分较高的患者中。定植患者更常发生感染性并发症。关于血液系统恶性肿瘤患者 GNB 定植者的口腔卫生实践存在知识空白。我们的结果表明，患者的卫生-饮食习惯，特别是经常看牙，是防止定植的一个保护因素。
