Xylitol Decreases Risk of Blood Stream Infections for Pediatric Bone Marrow Transplant Recipients

Published September 2020 | Biology of Blood and Bone Marrow Transplantation

When a child needs a bone marrow transplant, pain and low blood counts often deter regular toothbrushing. Yet poor oral hygiene can lead to bloodstream infections (BSIs) from oral bacteria, which can cause hospital readmission, and impact the success of the transplant. Is there an alternative strategy to improve oral health?

Xylitol is a commercially available, inexpensive, and non-toxic treatment that can be rapidly adopted into practice. Researchers led by first author Priscila Badia, MD, and senior authors Sarat Thikkurissy, DDS, MS, and Christopher Dandoy, MD, MSc, found that xylitol decreases BSIs from oral organisms after hematopoietic stem cell transplantation (HSCT).

To evaluate the impact of daily dental xylitol wipes, the team enrolled 35 pediatric HSCT recipients from the Cincinnati Children’s Bone Marrow Transplant Unit and age-matched healthy children. Participants were randomized into a standard of care (SOC) group or xylitol group. From the beginning of chemotherapy to 30 days after transplantation, researchers measured outcomes in oral health and BSIs from oral organisms.

In the xylitol group, participants had significantly lower rates of gingivitis, oral plaque, and oral ulcers compared with the SOC group. They also had no BSI from oral organisms and significantly lower abundance of potential BSI pathogens—an overall change in the bacterial flora.

“Based on our results, xylitol can provide parents and oncology teams with a cheap and minimally invasive way to take care of the mouth pre- and post-transplant,” Thikkurissy says. “This can help reduce poor outcomes and improve quality of life for children undergoing transplants.”

The team is now collaborating with cardiology researchers to explore the impact of xylitol on oral bacterial infections in transcatheter pulmonary valve implantation patients.

Decrease Potential BSI Pathogens in Xylitol Group

Xylitol reduces oral bacteria among children receiving bone marrow transplants.