A retrospective investigation of advanced periodontal disease as a risk factor for septicemia in hematopoietic stem cell and bone marrow transplant recipients.
OBJECTIVE
Septicemia is a cause of death in hematopoietic stem cell transplant (HSCT) recipients. Extraction of teeth with advanced periodontitis has been advocated before HSCT to prevent septicemia in myeloablated hosts. The primary aim of the present study was to determine impact of chronic periodontitis, as measured by radiographic alveolar bone loss, on septicemia and transplant mortality.


METHODS
A retrospective design was used to study 77 subjects who received pretransplant dental evaluation, panoramic radiography, and full myeloablative allogeneic HSCT to treat hematologic malignancies. Radiographic crestal alveolar bone loss was measured with a Schei ruler on all teeth. Microorganisms isolated from positive blood cultures within the first 100 days after transplant were categorized as of likely origin from periodontal, oral, or any body sites. Spearman correlation and logistic regression analysis assessed associations between positive blood cultures, mean subject whole-mouth percent radiographic crestal alveolar bone loss, and 100-day survival.


RESULTS
Radiographic crestal alveolar bone loss per study subject averaged 13% +/- 7%, with 18.2% exhibiting bone loss of 20% or greater. During the initial 100 days after transplant, 63.6% subjects yielded septicemia-associated positive blood cultures, with Staphylococcus epidermidis, Streptococcus mitis, Enterococcus faecalis, Streptococcus sanguis, Staphylococcus aureus, and Escherichia coli as the most common isolates recovered. No statistically significant associations were found between mean subject radiographic alveolar bone loss and septicemia of likely periodontal or oral origin.


CONCLUSIONS
In this preliminary study, no relationship was found between radiographic periodontal status and septicemia or mortality within the initial 100 days after transplant. A larger-sized, prospective study is warranted to further delineate the risk of septicemia from periodontal and other oral diseases in immunocompromised patients.
Akintoye
Sunday O
SO
Clinical Research Core and Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research (NIDCR), National Institute of Health (NIH), Bethesda, MD, 20892-4320 USA. sakitoye@dir.nidcr.gov
Brennan
Michael T
MT
Graber
Christopher J
CJ
McKinney
Beth E
BE
Rams
Thomas E
TE
Barrett
Austin J
AJ
Atkinson
Jane C
JC
D000328:Adult; D016301:Alveolar Bone Loss / Q000150:complications* / Q000000981:diagnostic imaging; D016470:Bacteremia / Q000209:etiology* / Q000382:microbiology*; D001420:Bacteria, Aerobic / Q000302:isolation & purification; D001421:Bacteria, Anaerobic / Q000302:isolation & purification; D015373:Bacterial Typing Techniques; D016026:Bone Marrow Transplantation / Q000401:mortality; D016009:Chi-Square Distribution; D002908:Chronic Disease; D017742:Dental Care for Chronically Ill; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality; D006801:Humans; D007165:Immunosuppression Therapy; D016015:Logistic Models; D016017:Odds Ratio; D010518:Periodontitis / Q000150:complications*; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric