Antibiotic sensitivity of bacteria on the oral mucosa after hematopoietic cell transplantation
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LETTER TO THE EDITOR
Antibiotic sensitivity of bacteria on the oral mucosa after hematopoietic cell transplantation Yoshihiko Soga & Yoshinobu Maeda & Mitsune Tanimoto & Takayuki Ebinuma & Hiroshi Maeda & Shogo Takashiba
Received: 27 April 2012 / Accepted: 10 September 2012 / Published online: 25 September 2012 # Springer-Verlag 2012
We reported recently that bacterial substitution of mainly coagulase-negative staphylococci (CoNS) for streptococci occurred frequently on the oral buccal mucosa after hematopoietic cell transplantation (HCT), and other bacterial species not usually found in the normal flora were also identified [1]. We also reported that multidrug-resistant opportunistic bacteria appearing in the gingiva may be involved in fatal sepsis [2]. These observations prompted an interest in the antibiotic sensitivity of bacteria after HCT, which may explain the bacterial substitution on oral mucosa after HCT. Therefore, we performed a pilot study to determine the antibiotic sensitivity of bacteria on the oral mucosa after HCT. We examined the antibiotic sensitivity of bacteria detected after HCT, focusing on the period from day 0 to 13, when the severity of clinically evident mucosal damage generally peaks and can cause bacteremia via the oral mucosa [3–5]. A total of nine consecutive patients (M, 4; F, 5; 47.3±11.0 years) receiving HCT at Okayama University Hospital were enrolled in this study. The diseases in these nine patients were as follows: acute myelogenous leukemia (n 03), myelodysplastic Y. Soga (*) Division of Hospital Dentistry, Central Clinical Department, Okayama University Hospital, Okayama, Japan e-mail: [email protected] Y. Maeda : M. Tanimoto Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan T. Ebinuma : H. Maeda : S. Takashiba Department of Pathophysiology–Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
syndrome (n01), and malignant lymphoma (n05). Autologous HCT, conventional allogeneic HCT, and reducedintensity HCT were administered to two (M, 2; F, 0; average, 61.0 years), five (M, 0; F, 5; 39.4±7.7 years), and two (M, 2; F, 0; average, 53.5 years) patients, respectively. Informed consent for examination of oral bacteria was obtained from each subject, and the Ethical Committee of Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences approved this study (no. 263). General infection control and oral management were performed as described in our previous report [1]. Briefly, fluoroquinolone for prophylaxis against bacterial infection was administered orally. Neutropenic fever was managed according to the guidelines of Hughes et al. [6]. A fourth-generation cephalosporin (e.g., cefepime) or carbapenem (e.g., meropenem) was administered intravenously as empirical antibiotic therapy. Buccal mucosal swab samples were obtained from each patient twice with a 1-week int
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