Top Line: Is Staph Aureus colonization associated with radiation dermatitis risk? And if so, does decolonization reduce dermatitis?
The Studies: We recently reviewed consensus guidelines for the prevention and management of radiation dermatitis. Here’s an interesting look at the link between skin bacteria and dermatitis. First, the authors performed a cohort study of patients receiving breast or head and neck radiation. They swabbed the nasal cavity for Staph Aureus, which was positive in 21.1%. Overall, 38.1% developed grade 2-3 dermatitis. The proportion of patients positive for Staph Aureus was nearly 3 times higher among those with grade 2+ dermatitis compared to those with grade 1 (34.5% v 12.8%). The same group then conducted a randomized trial in which 75 breast cancer patients and 2 head and neck cancer patients were randomized to bacterial decolonization prior to treatment. Bacterial decolonization consisted of a 5 day course of intranasal mupirocin 2% twice per day and chlorhexidine gluconate 4% body cleanser once daily. This was completed before starting RT and repeated every 2 weeks during RT. The majority of patients were Black (33.7%) or Hispanic (32.5%). Midway through the study, the primary endpoint was modified from any grade 2+ dermatitis to the rate of developing moderate to brisk erythema or moist desquamation. None of the patients who had bacterial decolonization experienced moderate to brisk erythema or moist desquamation compared to 23.7% in the standard arm. When looking at all grade 2 or higher dermatitis, the rate was higher without decolonization (52.6% v 35.9%), but this did not reach statistical significance. Patients were enrolled regardless of their colonization status, and only 13% had positive nasal swabs for Staph Aureus. Decolonization was effective with significantly fewer patients testing positive after treatment than in the standard arm (5.4% v 24.3%). However, it is unclear how much the results were driven by the patients who were positive for Staph Aureus.
TBL: Staph Aureus colonization is more common in patients who develop radiation dermatitis, and bacterial decolonization before and during radiation results in a lower rate of brisk erythema and moist desquamation. | Kost, JAMA Oncol 2023
The Studies: We recently reviewed consensus guidelines for the prevention and management of radiation dermatitis. Here’s an interesting look at the link between skin bacteria and dermatitis. First, the authors performed a cohort study of patients receiving breast or head and neck radiation. They swabbed the nasal cavity for Staph Aureus, which was positive in 21.1%. Overall, 38.1% developed grade 2-3 dermatitis. The proportion of patients positive for Staph Aureus was nearly 3 times higher among those with grade 2+ dermatitis compared to those with grade 1 (34.5% v 12.8%). The same group then conducted a randomized trial in which 75 breast cancer patients and 2 head and neck cancer patients were randomized to bacterial decolonization prior to treatment. Bacterial decolonization consisted of a 5 day course of intranasal mupirocin 2% twice per day and chlorhexidine gluconate 4% body cleanser once daily. This was completed before starting RT and repeated every 2 weeks during RT. The majority of patients were Black (33.7%) or Hispanic (32.5%). Midway through the study, the primary endpoint was modified from any grade 2+ dermatitis to the rate of developing moderate to brisk erythema or moist desquamation. None of the patients who had bacterial decolonization experienced moderate to brisk erythema or moist desquamation compared to 23.7% in the standard arm. When looking at all grade 2 or higher dermatitis, the rate was higher without decolonization (52.6% v 35.9%), but this did not reach statistical significance. Patients were enrolled regardless of their colonization status, and only 13% had positive nasal swabs for Staph Aureus. Decolonization was effective with significantly fewer patients testing positive after treatment than in the standard arm (5.4% v 24.3%). However, it is unclear how much the results were driven by the patients who were positive for Staph Aureus.
TBL: Staph Aureus colonization is more common in patients who develop radiation dermatitis, and bacterial decolonization before and during radiation results in a lower rate of brisk erythema and moist desquamation. | Kost, JAMA Oncol 2023