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Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen in erythrodermic cutaneous T-cell lymphoma (CTCL) patients

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Abstract

Erythroderma can occur in cutaneous T-cell lymphoma (CTCL). Staphylococcus aureus (S. aureus) prevalence is increased in CTCL patients and contributes to CTCL disease flares. Our primary aim was to describe S. aureus infections, including resistance patterns and the antibiotic treatment regimens used, in erythrodermic CTCL patients. This was a retrospective chart review of erythrodermic CTCL patients who had S. aureus infection or colonization and were treated at the UT MD Anderson Cancer Center’s Melanoma Skin Center between 2012 and 2016. Twenty-six erythrodermic CTCL patients had 50 documented S. aureus colonization or infection events. Patients had an improvement in body surface area (BSA) or modified Severity Weighted Assessment Tool (mSWAT) in 53% events treated for S. aureus. Seventeen of the 50 (34%) events were due to methicillin-resistant S. aureus (MRSA). One-third (33%) of MRSA events were initially treated with dicloxacillin. The MRSA isolates were sensitive to trimethoprim–sulfamethoxazole (92%) and doxycycline (88%). Patients treated in the outpatient setting (OR 0.073; 95% CI 0.008–0.627; p = 0.017) and patients with a previous history of topical anti-S. aureus decolonization treatments before S. aureus event as stand-alone (OR 0.125; 95% CI 0.018–0.887; p = 0.038) or in combination treatment with systemic antibiotics (OR 0.094; 95% CI 0.009–0.944; p = 0.045) were less likely to see improvement in BSA or mSWAT from S. aureus treatment. Treatment of S. aureus improved CTCL skin score in a high number of erythrodermic patients. The MRSA prevalence was high in erythrodermic CTCL patients. Clinicians should consider using empiric MRSA antibiotic coverage for these patients.

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Acknowledgements

Dr. Duvic holds the Blanche Bender Professorship in Cancer Research at MDACC. Funding for statistical analysis was supported in part by the National Cancer Institute’s Cancer Center Support Grant P30 CA016672. The research was supported by the MDACC Stanton Endowment and MDACC Stanton CTCL Research Fund.

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Authors and Affiliations

  1. Department of Internal Medicine, Baylor College of Medicine, Houston, TX, 77030, USA

    Drew A. Emge

  2. Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA

    Roland L. Bassett

  3. Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA

    Madeleine Duvic & Auris O. Huen

  4. 1110 Orchard Oriole Lane, Durham, NC, 27713, USA

    Drew A. Emge

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  1. Drew A. Emge
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  2. Roland L. Bassett
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Correspondence to Drew A. Emge.

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Emge, D.A., Bassett, R.L., Duvic, M. et al. Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen in erythrodermic cutaneous T-cell lymphoma (CTCL) patients. Arch Dermatol Res 312, 283–288 (2020). https://doi.org/10.1007/s00403-019-02015-7

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  • DOI: https://doi.org/10.1007/s00403-019-02015-7

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