981 The microbial flora of clinically infected cutaneous metastases

Abstract

Cutaneous metastases (CM) represent skin involvement from internal malignancies or in-transit metastases from high-risk skin cancers. Knowledge of the microbial flora of skin lesions in patients with cutaneous metastases is critical towards mitigating associated symptoms of discharge, malodor, and pain, all of which may negatively impact quality of life and cutaneous health. We characterized the microbiota and antimicrobial management of cutaneous metastases. We conducted a retrospective chart review of patients with symptomatic CM seen by Dermatology Service at Memorial Sloan Kettering Cancer Center between August 2006 and June 2015. We identified 64 patients with cutaneous metastases and clinical evidence of skin infection. Culture swabs yielded 17 distinct bacterial and fungal species. We detected pathogenic and/or opportunistic bacteria in 50% of skin lesions. The most commonly isolated organisms were Staphylococcus aureus and Pseudomonas aeruginosa. Patients treated with oral antibiotics, alone or in combination with topical agents, had a statistically significant better improvement in infectious symptoms than those treated without oral antibiotics. Our study showed that the normal skin microbial flora is disrupted in patients with infected skin metastases. Oral antibiotics may provide benefit when used as first-line therapy of infected skin lesions in patients with symptomatic cutaneous metastases. Further studies may include obtaining bacterial, viral, and fungal cultures of all patients with symptomatic cutaneous metastases and analysis of these samples using next-generation sequencing.