Improving Oral Health and Modulating the Oral Microbiome to Reduce Bloodstream Infections from Oral Organisms in Pediatric and Young Adult Hematopoietic Stem Cell Transplantation Recipients: A Randomized Controlled Trial

• Published in: Biology of blood and marrow transplantation 2020-09, Vol.26 (9), p.1704-1710
• Main Authors: 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.
• Format: Article
• Language: English
• Subjects: Bacteremia; Bloodstream infection; Child; Child, Preschool; Hematopoietic Stem Cell Transplantation; Humans; Microbiome; Microbiota; Mucosal barrier injury laboratory-confirmed bloodstream infection; Oral Health; Retrospective Studies; Sepsis; Transplantation, Homologous; Xylitol; Young Adult
• ISSN: 1083-8791; 1523-6536; 1523-6536
• DOI: 10.1016/j.bbmt.2020.05.019

•Bloodstream infections (BSIs) from oral organisms are a significant cause of morbidity and mortality in hematopoietic stem cell transplantation (HSCT) recipients.•The addition of xylitol to standard oral care significantly improves gingivitis and dental plaque in HSCT recipients.•The addition of xylitol to standard oral care may be associated with decreased BSIs from oral organisms after HSCT. 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 HS