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.
Level 2 - randomized trial
Individual randomized controlled trial
PubMed 32505810 · doi:10.1016/j.bbmt.2020.05.019
What was done
Pediatric and young adult hematopoietic stem cell transplantation (HSCT) recipients (>2 years old) were enrolled in a single-center 1:1 randomized controlled trial comparing standard of care (SOC) oral hygiene (n = 16) with SOC plus daily oral xylitol wipes containing 0.7 g xylitol (n = 14). The intervention started at the onset of conditioning chemotherapy and continued until day 28 post-transplantation. Age-matched healthy children were also enrolled for microbiome comparison. The primary outcome was oral health at scheduled time points; secondary outcomes were oral-organism bloodstream infections (BSIs) through day 30 post-transplantation, oral microbiome diversity, and pathogenic organism abundance.
What was found
The trial was stopped early for efficacy after an interim analysis of 30 HSCT recipients. The xylitol group experienced significantly less gingivitis at days 7 (P = .031), 14 (P = .0039), and 28 (P = .0005); less oral plaque at days 7 (P = .045) and 14 (P = .0023); and fewer oral ulcers >10 mm at day 14 (P = .049). There were 0 oral-organism BSIs in the xylitol group compared with 4 in the SOC group (P = .04). The day after transplantation, the xylitol group had significantly lower abundance of Staphylococcus aureus (P = .036), Klebsiella pneumoniae (P = .033), and Streptococcus spp (P = .011). Healthy controls had higher microbiome diversity than HSCT recipients (P < .001).
Why it matters
Adding xylitol wipes to standard oral care provides an accessible, non-invasive method to decrease mucosal damage and prevent oral-derived bloodstream infections in pediatric HSCT patients.
Limits
The study is single-center with a very small sample size (n = 30) resulting from early trial termination, which increases the risk of effect-size overestimation. Blinding details and the exact sample size for the healthy control cohort were not reported in the abstract.
Cited by
- supports Studies demonstrate that xylitol is beneficial for patients undergoing chemotherapy.