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. 2011 Dec;43(3):177-81.
doi: 10.5152/eajm.2011.34.

Incidence and risk factors of the secondary skin infections in patients with radiodermatitis

Ulku Altoparlak  1 , Ozlem Koca  1 , Timur Koca  2
Affiliations

Incidence and risk factors of the secondary skin infections in patients with radiodermatitis

Ulku Altoparlak et al. Eurasian J Med. 2011 Dec.

Abstract
in English, Turkish

Objective: The aim of this prospective study was to investigate the incidence and risk factors of secondary infected radiodermatitis in patients receiving radiotherapy and to determine isolated microorganisms' resistance profiles to different antimicrobial agents.

Materials and methods: The study comprised 62 patients admitted to the Regional Training and Research Hospital from January 2009 to January 2010. Radiodermatitis was graded according to the National Cancer Institute's Common Toxicity Criteria version 3.0. Potential risk factors for secondary infection were recorded and evaluated by univariate and multivariate analyses.

Results: In 62 patients, grade 1, 2, 3 and 4 radiodermatitis were observed in 33 (53.2%), 11 (17.7%), 8 (12.9%) and 10 (16.2%) patients, respectively. Skin infection secondary to radiodermatitis occurred in 14 patients (infected patients), 21.4%, 21.4% and 57.2% of whom had grade 2, 3 and 4 radiodermatitis, respectively. Forty-eight patients were found to be colonized with micoorganisms (colonized patients). In the univariate analysis, concurrent endocrine therapy and radiodermatitis grade differed significantly between infected and colonized patients (p<0.05). Multivariate analyses showed that the radiodermatitis grade was an independent risk factor for the acquisition of infection (p<0.05). The microbial pathogens isolated from patients with skin infection were seven methicillin-resistant coagulase-negative Staphylococcus (MRCNS) strains, three methicillin-resistant Staphylococcus aureus (MRSA) strains, two Candida sp., one methicillin-sensitive coagulase-negative Staphylococcus (MSCNS) strain and one methicillin-sensitive S. aureus (MSSA) strain. Staphylococci strains were more resistant to beta-lactam antibiotics. No glycopeptide resistance was found.

Conclusion: The results of this study indicate that high-grade radiodermatitis leads to an increased risk for secondary infection of the skin with pathogens.

Amaç: Bu prospektif çalışmada; radyoterapi alan hastalarda radyodermatite sekonder olarak gelişen infeksiyonların insidans ve risk faktörleri ile izole edilen mikroorganizmaların antibiyotiklere karşı direnç profillerinin araştırılması amaçlandı.

Gereç ve yöntem: Çalışmaya; Haziran 2009 ile Haziran 2010 tarihleri arasında, Erzurum Bölge Eğitim ve Araştırma Hastanesi’ne başvuran 62 hasta dahil edildi. Radyodermatitler, National Cancer Institute’s Common Toxicity Criteria version 3.0’a göre derecelendirildi. Sekonder infeksiyonlar açısından potansiyel risk faktörleri kaydedilerek, univariate ve multivariate analiz ile değerlendirildi.

Bulgular: Altmış iki hastanın; %53.2’si grade 1, %17.7’si grade 2, %12.9’u grade 3 ve %16.2’si grade 4 radyodermatit olarak derecelendirildi. 14 hastada (infekte hastalar) ise radyodermatite sekonder gelişen deri infeksiyonu saptandı. İnfekte hastaların %21.4’ü grade 2, %21.4’ü grade 3 ve %57.2’si grade 4 radyodermatite sahipti. 48 hastada izole edilen mikroorganizmalar kolonizasyon olarak değerlendirildi (kolonize hastalar). Univariate analizde; infekte ve kolonize hastalar arasında eş zamanlı endokrin tedavi uygulaması ve radyodermatitin derecesi anlamlı oranlarda farklı bulundu (p<0.05). Multivariate analizde ise; radyodermatitin derecesi sekonder infeksiyon için bir risk faktörü olarak saptandı. İnfeksiyonlu hastalardan; 7 metisiline dirençli koagülaz negatif Staphylococcus, 3 metisiline dirençli Staphylococcus aureus, 2 Candida sp., 1 metisiline duyarlı koagülaz negatif Staphylococcus ve 1 metisiline duyarlı S. aureus izole edildi. Tüm stafilokok suşlarının en dirençli olduğu antibiyotik grubu beta-laktam antibiyotikler olarak tespit edilirken, glikopeptidlere karşı bir direnç saptanmadı.

Sonuç: Çalışmanın sonunda yüksek grade radyodermatitin, sekonder deri infeksiyonları için bir risk faktörü olduğu saptanmıştır.

Keywords: Colonization; Radiodermatitis; Risk factors; Secondary skin infection.

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Figures

Figure 1.
Figure 1.
Microorganisms isolated from patients with radiodermatitis. MSCNS: Methicillin-sensitive, coagulase-negative Staphylococcus. MRCNS: Methicillin-resistant, coagulase-negative Staphylococcus. MRSA: Methicillin-resistant Staphylococcus aureus. MSSA: Methicillin-sensitive Staphylococcus aureus. NHS: Non-hemolytic streptococci.
Figure 2.
Figure 2.
The resistance of coagulase-negative staphylococci to antimicrobial agents. AMC: Amoxicillin/clavulanic acid, TMX: Trimethoprim/sulfamethoxasole, SAM: Ampicillin/sulbactam.
Figure 3.
Figure 3.
Resistance of Staphylococcus aureus strains to antimicrobial agents. AMC: Amoxicillin/clavulanic acid, TMX: Trimethoprim/sulfamethoxasole, SAM: Ampicillin/sulbactam.
See this image and copyright information in PMC

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