Little information is available regarding the effect of oral intervention on the outcome of hematopoietic stem cell transplantation (HSCT). We retrospectively analyzed the incidence of oral mucositis after allogeneic HSCT with or without oral intervention among 96 consecutive patients in our hospital between January 1988 and March 2006. We combined two oral intervention strategies: cryotherapy and oral health care. The former was applied beginning in 2003 for patients being treated with melphalan, and the latter, which was the study's main strategy, was applied to all HSCT recipients beginning in 2004. Oral mucositis was evaluated according to NCI CTCAE v3.0. The incidence of oral mucositis was 30.9% (17/55) in reduced-intensity stem cell transplantation (RIST), which was significantly lower than the 90.2% (37/41) in conventional stem cell transplantation (CST; P < 0.001). Among these 96 patients, severe oral mucositis was observed in 19 (46.3%) CST cases and in 6 (10.9%) RIST cases (P < 0.001). The occurrence of oral mucositis apparently decreased after oral health care instructions were given. Multiple logistic analysis revealed that the conditioning regimen and oral health care were independent risk factors for the incidence of oral mucositis. The cryotherapy did not exert enough potency to prevent oral mucositis in patients who had undergone CST or RIST. We concluded that oral health care improved tissue damage due to an overall upgrade in oral hygiene during chemotherapy.

Background Central venous catheters (CVCs) are necessary for critically ill patients, including those with hematological malignancies. However, CVC insertion is associated with inevitable risks for various adverse events. Whether ultrasound guidance decreases the risk of catheter-related infection remains unclear. Methods We observed 395 consecutive CVC insertions between April 2009 and January 2013 in our hematological oncology unit. Because the routine use of ultrasound guidance upon CVC insertion was adopted based on our hospital guidelines implemented after 2012, the research period was divided into before December 2011 (early term) and after January 2012 (late term). Results Underlying diseases included hematological malignancies and immunological disorders. In total, 235 and 160 cases were included in the early- and late term groups, respectively. The median insertion duration was 26 days (range, 2–126 days) and 18 days (range, 2–104 days) in the early- and late term groups, respectively. The internal jugular, subclavian, and femoral veins were the sites of 22.6, 40.2, and 25.7% of the insertions in the early term group and 32.3, 16.9, and 25.4% of the insertions in the late term group, respectively. The frequency of catheter-related bloodstream infection (CRBSI) was 1.98/1000 catheter days and 2.17/1000 catheter days in the early- and late term groups, respectively. In the subgroup analysis, the detected causative pathogens of CRBSI did not differ between the two term groups; gram-positive cocci, gram-positive bacilli, and gram-negative bacilli were the causative pathogens in 68.9, 11.5, and 14.8% of the cases in the early term group and in 68.2, 11.4, and 18.2% of the cases in the late term group, respectively. In the multivariate analysis to determine the risk of CRBSI, only age was detected as an independent contributing factor; the indwelling catheter duration was detected as a marginal factor. A significant reduction in mechanical complications was associated with the use of ultrasound guidance. Conclusions Ultrasound-guided CVC insertion did not decrease the incidence of CRBSI. The only identified risk factor for CRBSI was age in our cohort. However, we found that the introduction of ultrasound-guided insertion triggered an overall change in safety management with or without the physicians’ intent.

BackgroundExtended-spectrum β-lactamase (ESBL)-producing bacteria are resistant to several types of antibiotics excluding carbapenems. A transmissibility of ESBL-producing Enterobacteriaceae would be depending on each bacterial property, however, that has not been elucidated in clinical setting. In this study, we attempted to identify the source of an outbreak of ESBL-producing bacteria in a medical oncology and immunology care unit.MethodsAn ESBL-producing Enterobacteriaceae (ESBL-E) outbreak observed between July 2012 and August 2012 in Kagawa University Hospital was surveyed using various molecular microbiology techniques. We used Pulsed-field gel electrophoresis (PFGE), PCR-based ESBL gene typing, and direct sequence of ESBL gene as molecular microbiology typing method to distinguish each strain.ResultsThe typical prevalence of ESBL-E isolation in the unit was 7.0 per month (1.7 per week). The prevalence of ESBL-E isolation during the target research period was 20.0 per month (5.0 per week). In total, 19 isolates (11 K. pneumoniae and 8 E. coli) were obtained from clinical samples, including four control strains (two each of both bacteria), that were physically different from those obtained from other inpatient units in our hospital. Pulsed-field gel electrophoresis (PFGE) for K. pneumoniae (digested by XbaI) produced similar patterns excluding one control strain. PCR classification of the ESBL gene for K. pneumoniae revealed that all strains other than the control strain carried SHV and CTX-M-9. This result was reconfirmed by direct DNA sequencing. Although the outbreak of K. pneumoniae was considered to be “clonal,” PFGE and PCR classification of the ESBL genes for E. coli uncovered at least six different “non-clonal” strains possessing individual ESBL gene patterns. According to the result of an antibiogram, the pattern of antimicrobial susceptibility was more variable for K. pneumoniae than for E. coli.ConclusionsTyping by PFGE and ESBL gene PCR analysis is practical for discriminating various organisms. In our cohort, two outbreaks were concomitantly spread with different transmission strategies, namely clonal and non-clonal, in the same unit. This might represent clinical evidence that transmissibility differs according to the type of strain. We speculated that patient-to-patient transmission of ESBL-E occurred according to the properties of each individual strain.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-2144-4) contains supplementary material, which is available to authorized users.

Purpose For cancer-bearing patients, especially for patients with hematological malignancies, blood access is a ‘lifeline’ during chemotherapy, in three senses: administration of chemotherapy for the cancer treatment, intravenous supply of nutrients when a patient’s oral intake is decreased, and injection of many agents for supportive care including antibiotics and G-CSF. For these purposes, we usually use a central venous catheter (CVC) at the subclavian portion. Dressing and skin care of the CVC are critical factors influencing the incidence of catheter-related blood stream infection (CRBSI). To clarify the association between preventative procedures and CRBSI rates, we summarize the effectiveness of annually instituted interventions for the prevention of CRBSI and present the result of surveillance of catheter infection in our hospital for a decade, from 1998 to the present. Method This is a prospective cohort study analyzing patients seen in our hospital for the treatment of cancer and predicting neutropenia by observation of catheter infection. All of the patients underwent CVC (Microneedle Seldinger Kit, Safe Guide II, Argyle) insertion with a subclavian approach except for patients with subclavian venous troubles such as embolism or occlusion. Each year for the first five years, we instituted new precautions for preventing CRBSI. Those interventions were introducing low-irritant skin tape from 1999, applying the maximal barrier precaution (MBP) procedure from 2000, applying closed injection-line system (Interlink system; Japan Beckton Dickinson, Tokyo, Japan) from 2001, once-a-week dressing using adherent transparent film (Tegaderm; Sumitomo 3M, Tokyo, Japan) from 2002, and usage of one pair of glove in each procedure for an individual patient from 2003. More than 2 sets (One set means blood samples from peripheral blood and CVC) of blood culture samples were drawn when a patient’s body temperature (axillary) increased to more than 38.0 ºC. Multiple detection of the same isolate in the same individual during a series of febrile episode was considered as one infectious event. Bacteremia was defined as the isolation of at least one pathogen from at least one blood sample. BSI was defined as the recognition of a pathogen from one or more blood cultures that is not related to an infection at another site. CRBSI was defined as bacteremia in a patient with CVC with at least one positive pathogen obtained from a blood culture, and no apparent source for the BSI. We evaluated the duration of CVC insertion, episodes of febrile event, isolated bacteria and bacteremia. Results A total of 55,469 catheter-days were observed. The incidence of CRBSI per one thousand catheter-days was 8.08±2.76 before our interventions (before 1998), 4.18±2.59 after the low-irritant skin tape, 2.84±1.26 after the MBP procedure, 2.18±1.69 after the closed injection-line system, 2.84±2.17 after once-a-week dressing, and 2.53±2.63 after the individual-gloves intervention. After the introduction of MBP, the incidence of CRBSI was significantly decreased from before the start of interventions (P&lt;0.001). Though the subsequent interventions (closed line system, once-a-week dressing and individual-gloves intervention) did not apparently influence the incidence of CRBSI, they were believed to keep the incidence of BSI low. Conclusion Applying MBP and low-irritant tape was significantly effective for decreasing the incidence of CRBSI. A concomitant use of MBP and valid taping might be most influential for preventing CRBSI.

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