THE IMPACT OF MUCOSITIS ON ALPHA-HEMOLYTIC STREPTOCOCCAL INFECTION INPATIENTS UNDERGOING AUTOLOGOUS BONE-MARROW TRANSPLANTATION FOR HEMATOLOGIC MALIGNANCIES

BACKGROUND, Antibacterial prophylaxis with quinolone antibiotics has r esulted in an increase in streptococcal infections among bone marrow t ransplantation (BMT) recipients with myelosuppression. Oral ulceration (mucositis), which frequently occurs as a consequence of chemotherapy , has been implicated as a significant portal of entry for streptococc i. The objectives of this study were to confirm the correlation betwee n mucositis and streptococcal bacteremia, determine the risk associate d with this correlation, and evaluate the impact of mucositis and stre ptococcal bacteremia on hospital course and costs associated with auto logous BMT. METHODS. This was a retrospective, case-control study in w hich the charts of autologous BMT recipients treated for hematologic m alignancies between 1990 and 1996 were reviewed. Twenty-four patients were identified who met the criteria of autologous BMT; their blood cu ltures confirmed (x2) alpha-hemolytic streptococcal sepsis. A control group of 45 without positive cultures was matched by gender, age, diag nosis, and treatment to the study group. RESULTS. The results confirm that ulcerative mucositis is a significant risk factor for alpha-hemol ytic streptococcal bacteremia among autologous BMT patients. Of the 24 patients with bacteremia, 15 of 24 (62%) had ulcerative mucositis, co mpared with 16 of 45 (36%) of patients in the control population (P < 0.05). Patients with ulcerative mucositis were found to be three times as likely to develop alpha-hemolytic streptococcal bacteremia as thos e without ulcerative mucositis (odds ratio = 3.02). Both independently and as a cofactor associated with bacteremia, mucositis adversely aff ected the length of hospital stay (LOS). Of all the patients studied, those with oral ulcerations had a LOS of 34 days, compared with 29 day s for patients without Oral ulcerations (P < 0.05). Of patients in the study group, those with oral ulcerations stayed in the hospital 6 day s longer than patients without oral ulcerations (40 days vs. 34 days, P < 0.05). CONCLUSIONS. Oral ulcerative mucositis is a significant, co mmon, and important risk factor for cu-hemolytic streptococcal bactere mia in BMT recipients with myelosuppression; it results in longer hosp ital stay and increased costs. (C) 1998 American Cancer Society.