Abstract
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. 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. 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. The results of this study indicate that high-grade radiodermatitis leads to an increased risk for secondary infection of the skin with pathogens.
Highlights
Radiation therapy (RT), employed as monotherapy or in combination with surgery or with chemotherapy and surgery, has been reported as an effective regimen for tumor treatment [1]
Skin infection secondary to radiodermatitis occurred in 14 patients, 21.4%, 21.4% and 57.2% of whom had grade 2, 3 and 4 radiodermatitis, respectively
Multivariate analyses showed that the radiodermatitis grade was an independent risk factor for the acquisition of infection (p
Summary
Radiation therapy (RT), employed as monotherapy or in combination with surgery or with chemotherapy and surgery, has been reported as an effective regimen for tumor treatment [1]. The use of RT affects normal tissues adjacent to the cancer. Radiation injury to the skin is one of the most common adverse effects of radiation therapy [2]. Following a cumulative radiation dose exceeding 10 Gray, exposed skin often develops an intense local inflammatory reaction within 2 days to 1 week. The reaction peaks at 48 hours and subsequently subsides, only to be followed by a second phase of intense erythema with edema and vesiculation beginning 1 week after exposure and lasting up to 1 month. Pustules, and ulcerations may develop in association with secondary infection [3]
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