1
|
Kost Y, Deutsch A, Mieczkowska K, Nazarian R, Muskat A, Hosgood HD, Lin J, Daily JP, Ohri N, Kabarriti R, Shinoda K, McLellan BN. Bacterial Decolonization for Prevention of Radiation Dermatitis: A Randomized Clinical Trial. JAMA Oncol 2023; 9:940-945. [PMID: 37140904 PMCID: PMC10160991 DOI: 10.1001/jamaoncol.2023.0444] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/01/2023] [Indexed: 05/05/2023]
Abstract
Importance Evidence-based approaches for the prevention of acute radiation dermatitis (ARD) are limited, and additional strategies are necessary to optimize care. Objective To determine the efficacy of bacterial decolonization (BD) to reduce ARD severity compared with standard of care. Design, Setting, and Participants This phase 2/3 randomized clinical trial was conducted from June 2019 to August 2021 with investigator blinding at an urban academic cancer center and enrolled patients with breast cancer or head and neck cancer receiving radiation therapy (RT) with curative intent. Analysis was performed on January 7, 2022. Interventions Intranasal mupirocin ointment twice daily and chlorhexidine body cleanser once daily for 5 days prior to RT and repeated for 5 days every 2 weeks through RT. Main Outcomes and Measures The primary outcome as planned prior to data collection was the development of grade 2 or higher ARD. Based on wide clinical variability of grade 2 ARD, this was refined to grade 2 ARD with moist desquamation (grade 2-MD). Results Of 123 patients assessed for eligibility via convenience sampling, 3 were excluded, and 40 refused to participate, with 80 patients in our final volunteer sample. Of 77 patients with cancer (75 patients with breast cancer [97.4%] and 2 patients with head and neck cancer [2.6%]) who completed RT, 39 were randomly assigned BC, and 38 were randomly assigned standard of care; the mean (SD) age of the patients was 59.9 (11.9) years, and 75 (97.4%) were female. Most patients were Black (33.7% [n = 26]) or Hispanic (32.5% [n = 25]). Among patients with breast cancer and patients with head and neck cancer (N = 77), none of the 39 patients treated with BD and 9 of the 38 patients (23.7%) treated with standard of care developed ARD grade 2-MD or higher (P = .001). Similar results were observed among the 75 patients with breast cancer (ie, none treated with BD and 8 [21.6%] receiving standard of care developed ARD grade ≥2-MD; P = .002). The mean (SD) ARD grade was significantly lower for patients treated with BD (1.2 [0.7]) compared with patients receiving standard of care (1.6 [0.8]) (P = .02). Of the 39 patients randomly assigned to BD, 27 (69.2%) reported regimen adherence, and only 1 patient (2.5%) experienced an adverse event related to BD (ie, itch). Conclusions and Relevance The results of this randomized clinical trial suggest that BD is effective for ARD prophylaxis, specifically for patients with breast cancer. Trial Registration ClinicalTrials.gov Identifier: NCT03883828.
Collapse
Affiliation(s)
- Yana Kost
- Division of Dermatology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Alana Deutsch
- Division of Dermatology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Karolina Mieczkowska
- Division of Dermatology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Roya Nazarian
- Division of Dermatology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Ahava Muskat
- Division of Dermatology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - H. Dean Hosgood
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
- Department of Epidemiology and Population Health (Biostatistics), Albert Einstein College of Medicine, Bronx, New York
| | - Juan Lin
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
- Department of Epidemiology and Population Health (Biostatistics), Albert Einstein College of Medicine, Bronx, New York
| | - Johanna P. Daily
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Nitin Ohri
- Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York
| | - Rafi Kabarriti
- Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York
| | - Kosaku Shinoda
- Division of Endocrinology and Diabetes, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, New York
| | - Beth N. McLellan
- Division of Dermatology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| |
Collapse
|
2
|
Kost Y, Rzepecki AK, Deutsch A, Birnbaum MR, Ohri N, Hosgood HD, Lin J, Daily JP, Shinoda K, McLellan BN. Association of Staphylococcus aureus Colonization With Severity of Acute Radiation Dermatitis in Patients With Breast or Head and Neck Cancer. JAMA Oncol 2023; 9:962-965. [PMID: 37140927 PMCID: PMC10160990 DOI: 10.1001/jamaoncol.2023.0454] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/01/2023] [Indexed: 05/05/2023]
Abstract
Importance Pathogenesis of acute radiation dermatitis (ARD) is not completely understood. Pro-inflammatory cutaneous bacteria may contribute to cutaneous inflammation after radiation therapy. Objective To evaluate whether nasal colonization with Staphylococcus aureus (SA) before radiation therapy is associated with ARD severity in patients with breast or head and neck cancer. Design, Setting, and Participants This prospective cohort study with observers blinded to colonization status was conducted from July 2017 to May 2018 at an urban academic cancer center. Patients aged 18 years or older with breast or head and neck cancer and plans for fractionated radiation therapy (≥15 fractions) with curative intent were enrolled via convenience sampling. Data were analyzed from September to October 2018. Exposures Staphylococcus aureus colonization status before radiation therapy (baseline). Main Outcomes and Measures The primary outcome was ARD grade using the Common Terminology Criteria for Adverse Event Reporting, version 4.03. Results Among 76 patients analyzed, mean (SD) age was 58.5 (12.6) years and 56 (73.7%) were female. All 76 patients developed ARD: 47 (61.8%) with grade 1, 22 (28.9%) with grade 2, and 7 (9.2%) with grade 3. The prevalence of baseline nasal SA colonization was higher among patients who developed grade 2 or higher ARD compared with those who developed grade 1 ARD (10 of 29 [34.5%] vs 6 of 47 [12.8%]; P = .02, by χ2 test). Conclusions and Relevance In this cohort study, baseline nasal SA colonization was associated with development of grade 2 or higher ARD in patients with breast or head and neck cancer. The findings suggest that SA colonization may play a role in the pathogenesis of ARD.
Collapse
Affiliation(s)
- Yana Kost
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Alexandra K. Rzepecki
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Alana Deutsch
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Mathew R. Birnbaum
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Nitin Ohri
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, New York
| | - H. Dean Hosgood
- Department of Epidemiology and Population Health (Biostatistics), Albert Einstein College of Medicine, Bronx, New York
| | - Juan Lin
- Department of Epidemiology and Population Health (Biostatistics), Albert Einstein College of Medicine, Bronx, New York
| | - Johanna P. Daily
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Kosaku Shinoda
- Division of Endocrinology and Diabetes, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, New York
| | - Beth N. McLellan
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| |
Collapse
|
3
|
Cavana P, Robino P, Stella MC, Bellato A, Crosaz O, Fiora SR, Nebbia P. Staphylococci isolated from cats in Italy with superficial pyoderma and allergic dermatitis: Characterisation of isolates and their resistance to antimicrobials. Vet Dermatol 2023; 34:14-21. [PMID: 36221849 DOI: 10.1111/vde.13127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/15/2022] [Accepted: 08/04/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND In cats, superficial pyoderma traditionally is considered rare and few reports are available. There is a particular lack of studies concerning Staphylococcus species associated with pyoderma in subjects affected by allergic skin diseases. HYPOTHESIS/OBJECTIVES (i) To evaluate the association between Staphylococcus spp. and superficial pyoderma in allergic cats and (ii) to characterise isolated staphylococci and analyse their antimicrobial resistance patterns. ANIMALS Forty-one cats with allergic dermatitis and superficial pyoderma in Italy. MATERIALS AND METHODS Skin swabs were cultured for the isolation of Staphylococcus spp. Species identification was performed by matrix-assisted laser desorption/ionisation time of flight mass spectrometry and 16S-rRNA sequencing. Staphylococcus aureus isolates were further characterised by staphylococcal protein A gene-typing. Antimicrobial susceptibility was performed by the disk diffusion method. RESULTS Staphylococci were isolated from 36/41 cats sampled and 39 different isolates were identified. Uneven distribution of staphylococcal species was observed among different body locations. The 39 isolates were S. aureus (n = 15), S. felis (n = 10), S. pseudintermedius (n = 8) and other staphylococci (n = 6). Eight different S. aureus spa-types associated with human clonal complexes were identified. Antimicrobial resistance was observed to penicillin (56.4%), tetracycline (46.2%), enrofloxacin (33.3%), erythromycin (28.2%), amikacin (25.6%), clindamycin (23.1%), marbofloxacin (15.4%), gentamicin (12.8%), trimethoprim-sulfamethoxazole (10.3%), chloramphenicol (7.7%) and cefoxitin/oxacillin (5.1%). Fifteen isolates (38.4%) were multidrug-resistant while meticillin resistance was associated only with S. pseudintermedius. CONCLUSIONS AND CLINICAL RELEVANCE These results confirm that S. aureus, S. pseudintermedius, and S. felis are frequently associated with superficial pyoderma in allergic cats. Semi-synthetic penicillins remain a suitable first-line treatment in this study, yet the high prevalence of antimicrobial resistant isolates suggests that antimicrobial susceptibility testing should be performed routinely.
Collapse
Affiliation(s)
- Paola Cavana
- Department of Veterinary Sciences, University of Turin, Torino, Italy
| | - Patrizia Robino
- Department of Veterinary Sciences, University of Turin, Torino, Italy
| | | | | | - Odile Crosaz
- Centre Hospitalier Universitaire Vétérinaire d'Alfort, Maisons-Alfort, France
| | | | - Patrizia Nebbia
- Department of Veterinary Sciences, University of Turin, Torino, Italy
| |
Collapse
|
4
|
Yue H, Umehara Y, Trujillo-Paez JV, Peng G, Nguyen HLT, Chieosilapatham P, Kiatsurayanon C, Song P, Okumura K, Ogawa H, Ikeda S, Niyonsaba F. Exogenous factors in the pathogenesis of atopic dermatitis: Irritants and cutaneous infections. Clin Exp Allergy 2021; 51:382-392. [PMID: 33394511 DOI: 10.1111/cea.13820] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/09/2020] [Accepted: 12/30/2020] [Indexed: 12/15/2022]
Abstract
Atopic dermatitis (AD) is a chronic relapsing inflammatory cutaneous disease that is often associated with other atopic symptoms, such as food allergy, allergic rhinitis and asthma, leading to significant morbidity and healthcare costs. The pathogenesis of AD is complicated and multifactorial. Although the aetiology of AD remains incompletely understood, recent studies have provided further insight into AD pathophysiology, demonstrating that the interaction among genetic predisposition, immune dysfunction and environmental provocation factors contributes to its development. However, the increasing prevalence of AD suggests that environmental factors such as irritation and cutaneous infection play a crucial role in triggering and/or aggravating the disease. Of note, AD skin is susceptible to bacterial, fungal and viral infections, and microorganisms may colonize the skin and aggravate AD symptoms. Overall, understanding the mechanisms by which these risk factors affect the cutaneous immunity of patients with AD is of great importance for developing a precision medicine approach for treatment. This review summarizes recent developments in exogenous factors involved in the pathogenesis of AD, with special emphasis on irritants and microbial infections.
Collapse
Affiliation(s)
- Hainan Yue
- Department of Dermatology and Allergology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoshie Umehara
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | | | - Ge Peng
- Department of Dermatology and Allergology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hai Le Thanh Nguyen
- Department of Dermatology and Allergology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Panjit Chieosilapatham
- Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chanisa Kiatsurayanon
- Department of Medical Services, Institute of Dermatology, Ministry of Public Health, Bangkok, Thailand
| | - Pu Song
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ko Okumura
- Department of Dermatology and Allergology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hideoki Ogawa
- Department of Dermatology and Allergology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigaku Ikeda
- Department of Dermatology and Allergology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - François Niyonsaba
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Faculty of International Liberal Arts, Juntendo University Graduate School of Medicine, Tokyo, Japan
| |
Collapse
|
5
|
Lee K, Zhang I, Kyman S, Kask O, Cope EK. Co-infection of Malassezia sympodialis With Bacterial Pathobionts Pseudomonas aeruginosa or Staphylococcus aureus Leads to Distinct Sinonasal Inflammatory Responses in a Murine Acute Sinusitis Model. Front Cell Infect Microbiol 2020; 10:472. [PMID: 33014894 PMCID: PMC7498577 DOI: 10.3389/fcimb.2020.00472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/31/2020] [Indexed: 12/21/2022] Open
Abstract
Host-associated bacteria and fungi, comprising the microbiota, are critical to host health. In the airways, the composition and diversity of the mucosal microbiota of patients are associated with airway health status. However, the relationship between airway microbiota and respiratory inflammation is not well-understood. Chronic rhinosinusitis (CRS) is a complex disease that affects up to 14% of the US population. Previous studies have shown decreased microbial diversity in CRS patients and enrichment of either Staphylococcus aureus or Pseudomonas aeruginosa. Although bacterial community composition is variable across CRS patients, Malassezia is a dominant fungal genus in the upper airways of the majority of healthy and CRS subjects. We hypothesize that distinct bacterial-fungal interactions differentially influence host mucosal immune response. Thus, we investigated in vitro and in vivo interactions between Malassezia sympodialis, P. aeruginosa, and S. aureus. The in vitro interactions were evaluated using the modified Kirby-Bauer Assay, Crystal Violet assay for biofilm, and FISH. A pilot murine model of acute sinusitis was used to investigate relationships with the host immune response. S. aureus and P. aeruginosa were intranasally instilled in the presence or absence of M. sympodialis (n = 66 total mice; 3–5/group). Changes in the microbiota were determined using 16S rRNA gene sequencing and host immune response was measured using quantitative real-time PCR (qRT-PCR). In vitro, only late stage planktonic P. aeruginosa and its biofilms inhibited M. sympodialis. Co-infection of mice with M. sympodialis and P. aeruginosa or S. aureus differently influenced the immune response. In co-infected mice, we demonstrate different expression of fungal sensing (Dectin-1), allergic responses (IL-5, and IL-13) and inflammation (IL-10, and IL-17) in murine sinus depending on the bacterial species that co-infected with M. sympodialis (p < 0.05). The pilot results suggest that species-specific interactions in airway-associated microbiota may be implicated driving immune responses. The understanding of the role of bacterial-fungal interactions in CRS will contribute to development of novel therapies toward manipulation of the airway microbiota.
Collapse
Affiliation(s)
- Keehoon Lee
- Center for Applied Microbiome Sciences, The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, United States
| | - Irene Zhang
- Center for Applied Microbiome Sciences, The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, United States
| | - Shari Kyman
- Center for Applied Microbiome Sciences, The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, United States
| | - Oliver Kask
- Center for Applied Microbiome Sciences, The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, United States
| | - Emily Kathryn Cope
- Center for Applied Microbiome Sciences, The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, United States
| |
Collapse
|
6
|
Lee K, Zhang I, Kyman S, Kask O, Cope EK. Co-infection of Malassezia sympodialis With Bacterial Pathobionts Pseudomonas aeruginosa or Staphylococcus aureus Leads to Distinct Sinonasal Inflammatory Responses in a Murine Acute Sinusitis Model. Front Cell Infect Microbiol 2020. [DOI: 10.10.3389/fcimb.2020.00472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|