Etiology, Diagnostic Testing, and Dermatology Consultation Utilization in Skin Infections in Hematopoietic Stem Cell Transplant Patients: A 5-year Review

Abstract

Objectives: Hematopoietic stem cell transplantation (HSCT) patients are at higher risk of infection compared to their healthy counterparts. Aims were identity type and incidence of skin infections, describe the use of diagnostic tests, and identify the role of dermatology consults. Methods: In this single institution retrospective chart review, data were extracted from the medical record. A clinically diagnosed skin infection was defined as any skin pathology treated with antibiotics, antivirals, antifungals, or antiparasitics. The diagnostic tests data such as cultures, polymerase chain reactions (PCR), and direct fluorescent antibody (DFA) tests, and dermatology consultations were also collected. Results: A total of 92 patients and 143 skin infections were identified in the 5-year study period. The majority of infections occurred while the patient was not neutropenic. The infectious agents responsible for infections varied depending on a patient’s age, neutropenia status, graft-versus-host disease (GVHD) diagnosis, and transplant type. Only 25 infections (17%) received a dermatology consultation. On average, infections associated with dermatology consultation received a higher number of diagnostic tests compared to those that did not receive a dermatology consultation. Conclusions: The etiologies and severities of clinically identified skin infections in HSCT patients are varied and require continuous vigilance of dermatological health. Dermatologists are not necessarily the physician’s ordering more diagnostic. Therefore, earlier assessment by dermatologists might prevent excessive laboratory testing and earlier management of severe clinically identified infections. J Microbiol Infect Dis 2019; 9(2):59-67.