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

Year 2019, Volume: 09 Issue: 02, 59 - 67, 15.06.2019

Lymaries Velez Steven Toffel Elizabeth Tremblay Kairav Shah Jena Auerbach Kenneth Rand Kathryn Anne Potter Stacy G. Beal

https://doi.org/10.5799/jmid.574535

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.

Keywords

Skin infections, Hematopoietic Stem Cell Transplantation, Dermatology Consultation, Neutropenia

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