title: Periodontal status and bacteremia with oral viridans streptococci and coagulase negative staphylococci in allogeneic hematopoietic stem cell transplantation recipients: a prospective observational study.
abstract: OBJECTIVE
  This study was aimed to investigate whether any association could be found between the presence of an inflamed and infected periodontium (e.g., gingivitis and periodontitis) and the development of bacteremia during neutropenia following allogeneic hematopoietic stem cell transplantation (HSCT).
  
  
  METHODS
  Eighteen patients underwent a periodontal examination before HSCT. Patients were classified as periodontally healthy [all periodontal pocket depths (PPD) ≤ 4 mm and bleeding on probing (BOP) ≤ 10%) or as having gingivitis/periodontitis (PPD ≥ 4 mm and BOP > 10%]. Oral mucositis (OM) was scored using the daily mucositis score. Blood cultures were taken at least twice weekly.
  
  
  RESULTS
  Five patients were periodontally healthy, while 13 patients had gingivitis or periodontitis. Twelve patients (67%) developed bacteremia during neutropenia, of which 11 patients (61%) had one or more episodes of bacteremia due to coagulase-negative staphylococci (CONS, most often Staphylococcus epidermidis) or to oral viridans streptococci (OVS), or both. Patients with gingivitis/periodontitis more often had bacteremia than those with a healthy periodontium (p = 0.047), and BOP was associated with bacteremia (p = 0.049). All patients developed ulcerative OM, but its severity and duration were not associated with bacteremia. OM duration and the length of stay in the hospital were strongly correlated (R = 0.835, p ≤ 0.001).
  
  
  CONCLUSIONS
  This study indicates that periodontal infections may contribute to the risk of developing OVS and CONS bacteremia during neutropenia following HSCT. While our results point to the importance of periodontal evaluation and management before HSCT, further studies on periodontal contribution to systemic infectious complications are warranted.
authors.affiliation: Department of Periodontology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands. jraber@worldonline.nl
authors.forename: Judith E
authors.initials: JE
authors.lastname: Raber-Durlacher
authors.forename: Alexa M G A
authors.initials: AM
authors.lastname: Laheij
authors.forename: Joel B
authors.initials: JB
authors.lastname: Epstein
authors.forename: Matthew
authors.initials: M
authors.lastname: Epstein
authors.forename: Gerard M
authors.initials: GM
authors.lastname: Geerligs
authors.forename: Gordon N
authors.initials: GN
authors.lastname: Wolffe
authors.forename: Nicole M A
authors.initials: NM
authors.lastname: Blijlevens
authors.forename: J Peter
authors.initials: JP
authors.lastname: Donnelly
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D003030:Coagulase / Q000378:metabolism; D005260:Female; D005891:Gingivitis / Q000453:epidemiology* / Q000382:microbiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000453:epidemiology* / Q000209:etiology*; D010514:Periodontal Pocket / Q000453:epidemiology / Q000382:microbiology; D010518:Periodontitis / Q000453:epidemiology* / Q000382:microbiology; D011446:Prospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology; D013210:Staphylococcus / Q000378:metabolism; D013280:Stomatitis / Q000453:epidemiology / Q000382:microbiology; D013290:Streptococcal Infections / Q000453:epidemiology; D034363:Viridans Streptococci; D055815:Young Adult
chemical_list: D003030:Coagulase