Pilot study on transient bacteremia and blood stream infections after invasive dental procedures in patients with cancer and central venous catheters.

Abstract

e19575 Background: There is no consensus among cancer centers on whether or not to administer antibiotic prophylaxis to cancer patients with long-term central venous catheters (CVCs) before a dental procedure to prevent transient bacteremia and potentially, a blood stream infection (BSI). To our knowledge, there are no epidemiological studies or national or international guidelines that have looked at the incidence of transient bacteremia and/or BSI in patients who have cancer and a CVC. Methods: This prospective, IRB-approved, pilot study will evaluate 30 subjects undergoing a standardized dental cleaning procedure (without antibiotic prophylaxis) for development of transient bacteremia or established BSI. Blood cultures will be drawn before, 20 minutes, 30 minutes and 24 hours post-procedure initiation. Periodontal health will be measured pre-procedure in order to correlate possible poor periodontal status with increased rate of positive blood culture or BSI. The data will be reported as the cumulative incidence rates for bacteremia at all time-points after procedure initiation, with exact binomial 95% confidence intervals. Results: 9 subjects have been recruited to the study. Only 2 out of 36 blood cultures (4 per subject) were positive. Both positive cultures were taken 20 minutes after initiating the dental cleaning. The organisms identified were Streptococcus mutans and Prevotella species, which are both oral commensals. Conclusions: Preliminary results demonstrate that transient bacteremia rates in patients with cancer with CVCs appear comparable to previous reports in a population of individuals without cancer. The patients with the two positive blood cultures did not develop BSI. The present work is innovative, because this will be the first study, to our knowledge, that examines the natural history of transient bacteremia in patients with cancer who have long term CVCs. This work is being supported by the University of Connecticut Health Center/HERA Foundation Seed Grant and the University of Connecticut Health Center/General Clinical Research Center (NIH M01R006192). No significant financial relationships to disclose.