The role of oral microbiota in the development of oral mucositis in pediatric oncology patients treated with antineoplastic drugs: A systematic review

Abstract

Abstract Background Oral mucositis as a consequence of chemotherapy in the pediatric oncology population is a highly prevalent complication and strongly affects both the quality of life and treatment possibilities of the patients. Etiopathological mechanisms carrying to its development are not fully understood. A possible role of oral disbiosis has previously been investigated with unclear conclusions. Aim of this systematic review was to assess the available evidence on the role of microbiota in the development of oral mucositis. Methods Systematic literature search was performed following PRISMA guidelines. Three electronic databases were searched up until April 2023. A following manual search included the reference lists of the included studies and reviews. Studies reporting microbiological and clinical data of pediatric patients treated by antineoplastic drugs were included. Results Thirteen studies met the inclusion criteria, reporting an average mucositis prevalence of 55%. Candida albicans infection was frequently observed in studies performing microbiological analysis on oral lesions, in contrast with the low rate detection of Herpes simplex viruses. Bacterial species such as coagulase-negative Staphylococcus aureus and Streptococcus viridans were more frequently detected on lesion sites. Studies reporting a quantitative analysis of the general flora did not show comparable results. Risk of bias assessment among studies was generally considered high or very high. Conclusions While the specific role of certain microbiological agents, such as Candida albicans, was frequently reported among studies, data regarding the general dynamics of oral microbiota in the development of oral mucositis are lacking in the current literature and more studies are needed to provide the knowledge required in order to improve protocols for the prevention and treatment of this threatening complication.