Objective
We monitored the epidemiology and microbiology of oral yeast colonization in patients
undergoing hemopoietic progenitor cell transplantation (HPCT) to examine associations
between yeast colonization and oral mucositis.
Study Design
One hundred twenty-one consecutive HPCT patients were sampled for oral yeasts prior
to fluconazole (FLC) prophylaxis, at transplantation, and weekly until discharge.
Clinical oral mucositis screenings were performed triweekly.
Results
Yeast colonization was evident at 216 of 510 total visits. Candida albicans and Candida glabrata were the predominant organisms. Eight patients showed elevated minimal inhibitory
concentrations to FLC. One patient developed fungal septicemia. Patients with oral
mucositis assessment scale scores <20 had higher colonization rates than those with
higher scores.
Conclusions
FLC is effective in controlling a variety of oral yeasts in HPCT recipients. FLC-resistant
yeasts do emerge and can be the source of fungal sepsis. A positive association was
not shown between yeast colonization and the presence or severity of oral mucositis.
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References
- Hematopoietic stem-cell transplantation.N Engl J Med. 2006; 354: 1813-1826
- Advances in hematologic stem cell transplant: an update for oral health care providers.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 107: 301-312
- Prospective surveillance for invasive fungal infections in hematopoietic stem cell transplant recipients, 2001-2006: overview of the Transplant-Associated Infection Surveillance Network (TRANSNET) Database.Clin Infect Dis. 2010; 50: 1091-1100
- Fungal infection prevention after hematopoietic cell transplantation.Bone Marrow Transplant. 2009; 44: 483-487
- Current approaches in antifungal prophylaxis in high risk hematologic malignancy and hematopoietic stem cell transplant patients.Mycopathologia. 2009; 168: 299-311
- A controlled trial of fluconazole to prevent fungal infections in patients undergoing bone marrow transplantation.N Engl J Med. 1992; 326: 845-851
- Candida glabrata sepsis secondary to oral colonization in bone marrow transplantation.Med Mycol. 2004; 42: 479-481
- Candida krusei sepsis secondary to oral colonization in a hemopoietic stem cell transplant recipient.Med Mycol. 2007; 45: 187-190
- Prospective oral mucositis audit: oral mucositis in patients receiving high-dose melphalan or BEAM conditioning chemotherapy—European Blood and Marrow Transplantation Mucositis Advisory Group.J Clin Oncol. 2008; 26: 1519-1525
- Oral bacteria and yeasts in relationship to oral ulcerations in hematopoietic stem cell transplant recipients.Support Care Cancer. 2012; 20: 3231-3240
- Updated clinical practice guidelines for the prevention and treatment of mucositis.Cancer. 2007; 109: 820-831
- Perspectives on cancer therapy-induced mucosal injury: pathogenesis, measurement, epidemiology, and consequences for patients.Cancer. 2004; 100: 1995-2025
- In-hospital complications of autologous hematopoietic stem cell transplantation for lymphoid malignancies: clinical and economic outcomes from the Nationwide Inpatient Sample.Cancer. 2008; 112: 1096-1105
- Simple method for detecting fluconazole-resistant yeasts with chromogenic agar.J Clin Microbiol. 1996; 34: 1794-1797
- WHO handbook for reporting results of cancer treatment.World Health Organization, Geneva1979
- Validation of a new scoring system for the assessment of clinical trial research of oral mucositis induced by radiation or chemotherapy. Mucositis Study Group.Cancer. 1999; 85: 2103-2113
- Reference method for broth dilution antifungal susceptibility testing of yeasts; approved standard.3d ed. Clinical and Laboratory Standards Institute, Wayne, PA2008 (p. M27-A3)
- Development of interpretive breakpoints for antifungal susceptibility testing: conceptual framework and analysis of in vitro–in vivo correlation data for fluconazole, itraconazole, and Candida infections.Clin Infect Dis. 1997; 24: 235-247
- Loss of in vitro resistance in Candida glabrata following discontinuation of fluconazole prophylaxis in a hematopoietic stem cell transplantation patient.Med Mycol. 2010; 48: 557-560
- Oral candidiasis in hematopoietic cell transplantation patients: an outcome-based analysis.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003; 96: 154-163
Article info
Publication history
Published online: January 10, 2013
Accepted:
October 19,
2012
Received in revised form:
October 9,
2012
Received:
August 9,
2012
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
