The effect of polyvinylpyrrolidone-sodium hyaluronate gel (Gelclair) on oral microbial colonization and pain control compared with other rinsing solutions in patients with oral mucositis after allogeneic stem cells transplantation.

BACKGROUND: Gelclair is an oral lubricating gel used in the management of oral mucositis (OM). We evaluated its efficacy, tolerance and impact on oral cavity microbial colonization in patients with OM after allogeneic hematopoietic stem cells transplantation. MATERIAL/METHOD: Gelclair was administered in a group of 22 patients with active OM. A control group of 15 patients used other rinsing solutions (chlorhexidine, benzydamine, salvia). Tests with oral cavity swabs for microbiology analysis were performed once a week. RESULTS: The characteristics of OM in both groups were comparable, and rinsing solutions had satisfactory tolerability. There was no difference in the median improvement of oral intake and OM-related pain relief, which was assessed mostly as "slight effect". In the Gelclair group, the effect duration was longer (median 3 [0-5] vs. 1 [0-3] hours, p = 0.001). There was significant increase of Enterococcus faecalis and Candida sp. colonization of the oral cavity over the course of the hospitalization and significantly reduced incidence of such colonization in patients with OM in the Gelclair group: 1/22 (5%) vs. 6/15 (40%), p = 0.01. In vitro tests showed inhibited growth of Enterococcus faecalis and Candida sp. colonies within the area of the Gelclair application. CONCLUSIONS: Gelclair may be individually helpful in the management of OM and pain in patients after allogeneic stem cells transplantation. Its use did not lead to worsened oral bacterial and yeast colonization and probably even helped to protect mucosa from Enterococcus and Candida sp. Further studies based on larger cohorts are needed.

Antimicrobial chlorhexidine/silver sulfadiazine-coated central venous catheters versus those uncoated in patients undergoing allogeneic stem cell transplantation.

INTRODUCTION: Only a minimum is known about clinical effect of antimicrobial-coated central venous catheters (CVC) in stem cell transplantation settings, where CVC-related infections impose major threat to severely immunocompromised patients. MATERIALS AND METHODS: In this prospective, non-sponsored and nonrandomized study, there were 49 uncoated multi-lumen and non-tunneled CVCs and 58 antimicrobial chlorhexidine/silver sulfadiazine-coated CVCs inserted in allogeneic stem cell transplanted patients to facilitate treatment during conditioning and pre-engraftment phase (<30days after transplantation). RESULTS AND DISCUSSION: No significant differences were found between the two groups with respect to gender, age, intensity of pretransplant chemotherapy conditioning, duration of leucopenia, number of days with inserted CVC, number of CVC occlusive dressing changes performed per patient, and number of non-CVC-related infections. In the antimicrobial coated CVC group, there were observed less median days with fever [2 (0-18) vs. 4 (0-16), p = 0,17], fever incidence (67% vs. 77.5%, p = 0.28), and less days with fever per 1,000 catheter-days (108 vs. 147, p = 0.001), less patients with positive CVC blood cultures (36% vs. 45%, p = 0.05), repeatedly positive CVC blood cultures (8.6% vs. 26%, p = 0,018), less positive CVC blood cultures per 1,000 catheter-days (14 vs. 29, p = 0.005), and less positive CVC tip cultures (17.3% vs. 34.6%, p = 0.065) observed. CONCLUSION: Lower number of patients with fever, days with fever, and lower number of patients with positive and repeatedly positive CVC blood cultures indicates less intensive antibiotic and antipyretic treatment probably needed in neutropenic allo-transplanted patients with indwelling antimicrobial-coated CVCs. Real impact on antibiotic consumption should be verified in large randomized study.