Background: Patients who have undergone hematopoietic stem cell transplantation (HSCT) are at a higher risk of infection compared to their healthy counterparts. This retrospective chart review aimed to elucidate the incidence and etiology of skin infections in HSCT patients and understand the relationship between these infections and graft-versus host disease (GVHD), neutropenia, and transplant type.
Methods: We reviewed all adult and pediatric HSCT patients who had at least one skin infection within the past 5 years for a total of 92 patients and 143 infections. The most common indications for transplant were acute myeloid leukemia (AML, n=22), multiple myeloma (MM, n=15), non-Hodgkin lymphoma (NHL, n=10), and acute lymphoblastic leukemia (ALL, n=10). A wide variety of infections were found, including herpes simplex virus/varicella zoster virus (n=30); a single bacterial pathogen (n=27), and a noncellulitis infection in which no organism was identified (n=25). Infections in which no organism was identified are defined as those infections which were either empirically treated or those that received diagnostic testing with negative results and were then empirically treated. Data was collected concerning the patient’s neutropenia status at infection onset, GVHD diagnosis, and transplant type.
Results: A high proportion (86.7%) of infections in our study were in adults. About a third (31.5%) of infections occurred when neutropenia (defined as <1500 cells/microliter) was present at infection onset. No organism was identified in a higher proportion of infections in patients with no GVHD diagnosis (36%) and autologous transplant patients (37%) compared to those with GVHD (27%) or allogeneic transplant (27%), respectively. Patients who received an allogeneic transplant had a higher proportion of infections (62.9%) compared with those who received autologous transplants (37.1%), and all major fungal infections, excluding dermatophytes, occurred in those with allogeneic transplants. Within our patient population, autologous transplant patients had a higher number of skin infections on average, 1.66 infections compared with 1.43 infections in those with an allogeneic transplant. The proportion of infections in those with GVHD versus those without GVHD were evenly split, 50.4% and 49.7%, respectively. Those with allogeneic transplants (28%) and GVHD (28%) had a higher proportion of herpes (HSV/VZV) infections compared to those with autologous transplants (9%) and no GVHD (14%).
Conclusions: Many studies have assessed infections in HSCT patients, however, none have focused on skin infections specifically. However, this study has found that the etiologies of skin infections in HSCT patients are complex with multi-faceted risk factors, which emphasizes the need for constant vigilance on the dermatological health of these patients.