aclarubicin and Bacterial-Infections

The purpose of the study was to evaluate the effect of a mouthrinse regimen comprising both chemical plaque control and mechanical plaque removal. 20 adult patients with acute myeloid leukaemia were assigned to one of the following 2 regimens: (1) (group 1) mouthrinse twice daily with a 0.1% chlorhexidine solution; or (2) (group 2) the same regimen, but preceded by mechanical removal of plaque and calculus on day 1. All patients were followed for 28 days from the initiation of remission-induction therapy. In group 2, the plaque scores remained lower than those of group 1 throughout the study, although only 3 patients remained completely free of plaque after 28 days. Gingival inflammation as judged by bleeding scores remained unchanged in group 1, whereas in group 2, the degree of inflammation was reduced from 52% (median value) on day 1 to 31% (median value) on day 28. The bleeding scores were also lower in group 2 (31%) than in group 1 (60%) on day 28. No differences were found between the 2 groups with respect to the occurrence of other oral infections. It is concluded that chemical plaque control with chlorhexidine should be preceded by mechanical removal of plaque and calculus, when used in patients with acute myeloid leukaemia and thrombocytopenia.

Topics: Aclarubicin; Acute Disease; Adolescent; Aged; Antineoplastic Combined Chemotherapy Protocols; Bacterial Infections; Chlorhexidine; Cytarabine; Dental Calculus; Dental Plaque; Dental Scaling; Female; Gingival Hemorrhage; Gingivitis; Humans; Leukemia, Myeloid; Leukopenia; Male; Middle Aged; Mouthwashes; Netilmicin; Piperacillin; Premedication; Thrombocytopenia

To investigate changes in the aerobic and facultatively anaerobic oral microflora during remission-induction chemotherapy in patients with acute myeloid leukaemia, 10 consecutive patients were studied during a period of 28 days. During antineoplastic treatment, the concentration of microorganisms in saliva doubled from day 0 to day 2, presumably as a result of a concurrent 64% decrease in the salivary flow rate. No changes in the relative proportion of individual microorganisms or acquisition of new microorganisms occurred during antineoplastic treatment. During antibacterial treatment, which was subsequently initiated in all patients, a 100-fold decline occurred in the median salivary concentration of microorganisms within the first 7 days. During this period, members of the normal flora became undetectable in 5 patients, and Enterobacteriaceae, Enterococcus faecalis or Candida spp. became parts of the quantitatively predominant oral microflora in 7 patients. Apart from Candida spp., these potentially pathogenic microorganisms were acquired only after the initiation of the antibacterial treatment. After termination of the antibacterial treatment, the median concentration of microorganisms increased again to the original level and normal flora became reestablished within a period of 8 days. Clinically, 10/20 acute oral infections emerged before day 8, i.e. within the period with increased concentrations of microorganisms in saliva. Specifically, the clinical diagnosis of acute oral candidiasis was associated with a rise in the concentration of Candida spp. above a critical value of 1,000 CFU/ml. Herpes simplex virus (HSV) type 1 was detected in 4/9 HSV-seropositive patients on days 14 and 21, and HSV-1 was in all 4 cases isolated simultaneously with the emergence of an intraoral ulcer. The results suggest that chemotherapy-induced xerostomia plays a significant role in the pathogenesis of acute oral infections and transmission of potentially pathogenic microorganisms is of importance mainly after initiated antibiotic treatment in these patients.

Topics: Aclarubicin; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Bacteria, Aerobic; Bacteria, Anaerobic; Bacterial Infections; Candidiasis; Cytarabine; Enterobacteriaceae; Enterococcus faecalis; Female; Humans; Leukemia, Myeloid, Acute; Male; Middle Aged; Mouth; Mouth Diseases; Prospective Studies; Remission Induction; Saliva