ORAL CARE WITH VANCOMYCIN PASTE FOR REDUCTION IN INCIDENCE OF ALPHA-HEMOLYTIC STREPTOCOCCAL SEPSIS

Purpose: alpha-Hemolytic streptococcal (AHS) sepsis is increasing in o ncology patients receiving myelosuppressive chemotherapy. In response to a high rate of AHS sepsis in this population at our institution, an oral care protocol was instituted, including vancomycin 0.5% in flavo red methylcellulose (vane paste) applied orally t.i.d. at the oncologi sts' discretion. Patients and Methods: A retrospective cohort study of 239 neutropenic episodes among 42 children receiving myelosuppressive chemotherapy between 1988 and 1991 compared the incidence of septicem ia based on the prophylactic use of vane paste. Results: A total of 23 6 consecutive neutropenic episodes were evaluable, 121 with vane paste and 115 without. AHS sepsis occurred in one child using vane paste an d in six children not using vane paste (p = 0.06). Excluding staph-onl y positive blood cultures, which would not be reduced with a topical o ral antibiotic drug, there were 6 and 13 positive blood cultures in th e vane-paste and nonvanc-paste patients, respectively (p = 0.09). Ther e was no increase in incidence of gram-negative bacteremia among vanc- paste recipients. Vancomycin resistance was not encountered. Conclusio n: This analysis suggests that vane paste effectively reduces AHS seps is, does not increase gram-negative bacteremia, and is not associated with vancomycin resistance. A multicentered, placebo-controlled, doubl e-blind study is currently planned.