Journal Article

Oral foci of infection and their relationship with hospital stay after haematopoietic cell transplantation

van Leeuwen, Stephanie J. M., Bronkhorst, Ewald M., Thomas, Renske Z., Huysmans, Marie-Charlotte D. N. J. M., Hannink, Gerjon, Blijlevens, Nicole M. A., van Gennip, Lucky L. A., Bulthuis, Marjolein S.

2024

Overview

Purpose Oral focus screening is recommended before HCT (haematopoietic cell transplantation). Acute foci are generally treated pre-HCT. However, it is unclear whether chronic foci should be treated pre-HCT. This study aimed to evaluate the association between number of foci and early post-HCT morbidity and mortality. Methods Patients who received an oral screening pre-HCT at Radboudumc between 2013 and 2023, with a recent panoramic radiograph, were included. Foci were defined as teeth or implants with deep pockets, furcation radiolucencies, periapical radiolucencies, deep caries, partial eruption or retained roots. Dental interventions were provided pre-HCT if deemed necessary and possible. Hospital length of stay (LOS), mortality and oral exacerbations were assessed in the first hundred days post-HCT. Hospital LOS was log-transformed to normalize its skewed distribution. Multivariate regression analyses were performed. Results Five hundred patients were included (median age 58 years, 37% female, 56% allogeneic). Four acute foci in two patients remained untreated pre-HCT. Forty-eight percent had at least one untreated chronic focus pre-HCT (mostly furcation radiolucencies and post-endodontic periapical lesions). Mean LOS was 22 days; 20 patients died, and four patients had an oral exacerbation before HCT day + 100. After adjustment for conditioning intensity, age, socioeconomic status and number of teeth, HCT recipients with ≥ 3 foci had five additional days in the hospital compared to those without foci (ratio of means 1.21; 95% CI 1.00 – 1.46). The number of foci was not associated with early post-HCT mortality. Conclusion The presence of ≥ 3 oral foci is associated with extended hospital LOS in the first hundred days post-HCT.

• Publisher: Springer Berlin Heidelberg,Springer,Springer Nature B.V
• Subject: Adult / Aged / Caries / Clinical decision making / Conditioning / Diagnostic tests / Eruption / Female / Gum disease / Health aspects / Health risks / Hematopoietic Stem Cell Transplantation - adverse effects / Hematopoietic Stem Cell Transplantation - methods / Hematopoietic stem cells / Humans / Implant dentures / Implants / Infections / Length of stay / Length of Stay - statistics & numerical data / Lesions / Male / Medical screening / Medicine / Medicine & Public Health / Middle Aged / Morbidity / Mortality / Mouth Diseases - epidemiology / Mouth Diseases - etiology / Nursing / Nursing Research / Oncology / Oral diseases / Pain Medicine / Patients / Radiography, Panoramic - methods / Rehabilitation Medicine / Retrospective Studies / Socioeconomic factors / Socioeconomic status / Stem cell transplantation / Teeth / Transplantation