title: Incidence and risk factors of the secondary skin infections in patients with radiodermatitis.
abstract: OBJECTIVE
  The aim of this prospective study was to investigate the incidence and risk factors of secondary infected radiodermatitis in patients receiving radiotherapy and to determine isolated microorganisms' resistance profiles to different antimicrobial agents.
  
  
  METHODS
  The study comprised 62 patients admitted to the Regional Training and Research Hospital from January 2009 to January 2010. Radiodermatitis was graded according to the National Cancer Institute's Common Toxicity Criteria version 3.0. Potential risk factors for secondary infection were recorded and evaluated by univariate and multivariate analyses.
  
  
  RESULTS
  In 62 patients, grade 1, 2, 3 and 4 radiodermatitis were observed in 33 (53.2%), 11 (17.7%), 8 (12.9%) and 10 (16.2%) patients, respectively. Skin infection secondary to radiodermatitis occurred in 14 patients (infected patients), 21.4%, 21.4% and 57.2% of whom had grade 2, 3 and 4 radiodermatitis, respectively. Forty-eight patients were found to be colonized with micoorganisms (colonized patients). In the univariate analysis, concurrent endocrine therapy and radiodermatitis grade differed significantly between infected and colonized patients (p<0.05). Multivariate analyses showed that the radiodermatitis grade was an independent risk factor for the acquisition of infection (p<0.05). The microbial pathogens isolated from patients with skin infection were seven methicillin-resistant coagulase-negative Staphylococcus (MRCNS) strains, three methicillin-resistant Staphylococcus aureus (MRSA) strains, two Candida sp., one methicillin-sensitive coagulase-negative Staphylococcus (MSCNS) strain and one methicillin-sensitive S. aureus (MSSA) strain. Staphylococci strains were more resistant to beta-lactam antibiotics. No glycopeptide resistance was found.
  
  
  CONCLUSIONS
  The results of this study indicate that high-grade radiodermatitis leads to an increased risk for secondary infection of the skin with pathogens.
authors.affiliation: Department of Microbiology and Clinical Microbiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey.
authors.forename: Ulku
authors.initials: U
authors.lastname: Altoparlak
authors.affiliation: Department of Microbiology and Clinical Microbiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey.
authors.forename: Ozlem
authors.initials: O
authors.lastname: Koca
authors.affiliation: Department of Radiation Oncology, Regional Training and Research Hospital, Erzurum, Turkey.
authors.forename: Timur
authors.initials: T
authors.lastname: Koca
keywords: Colonization; Radiodermatitis; Risk factors; Secondary skin infection