Abstract
Background: Cutaneous T-Cell Lymphoma (CTCL) currently affects over 10.2 million people worldwide. Staphylococcal enterotoxin producing Staphylococcus aureus plays an important role in the pathogenesis of the disease. Studies indicate that treatment of skin and soft tissue infections lead to clinical and symptomatic improvement in the erythrodermic appearance of CTCL. Not only does the bacteria play a role in cutaneous severity of the cancer, but also it is widely thought that presence of colonization correlates with severity of disease on a molecular level as well. The following study looked to see if race played a role in the rate and severity of colonization of these patients. Secondarily, the study looked to investigate survival amongst this group as well as how other factors such as age, gender and socioeconomic group played a role in colonization in this population.
Methods: Patients were identified from an existing CTCL database at Emory University. Patients with a cutaneous culture and histopathologic evidence of Sezary syndrome (SS) or Mycosis fungoides (MF) seen between 2020 and 2024 were eligible. Colonization was defined as a positive cutaneous culture result. Comparison between Black and White patients was performed using ANOVA for numerical covariates and Chi-square test or Fisher's exact test for categorical covariates. Overall survival (OS) was defined as the time from diagnosis to death or last follow-up. Patients not experiencing an event were censored at their last known follow-up. OS was determined using the Kaplan-Meier method, and univariate and multivariable Cox regression models were developed to identify predictors of OS. For binary outcomes, logistic regression was performed.
Results: The population included 213 patients, 96 patients (45.1%) self-identified as white and 117 (54.9%) as Black. Forty-nine patients (23%) were colonized, 40 (18.8%) had S. aureus, and 42 (21.5%) developed bacteremia. Racial differences were evaluated among Black and White patients. Black patients were more likely to become bacteremic after colonization than white patients (p<.0008). Nineteen (19.8%) of White patients and 30 (25.6%) of white patients had positive skin cultures; MRSA was seen in 6 (6.2%) of White and 12 (10.2%) Black patients, but this did not reach statistical significance.
Multivariate analysis indicated that women were more likely to have MSSA when compared to men, (OR=2.76; p<0.038). The analysis also demonstrated that those older than 60 were less likely to become bacteremic (p< 0.036), however had a lower survival rate if infected (p<0.015).
Discussion: In spite of higher degrees of bacteremia among Black patients, analysis of cutaneous cultures did not indicate differences in rates of colonization. Limitations include cultures were performed per standard of care and therefore we were not able to control for topical/oral antibiotics, and differences in hygiene practices or medications. Additional need for studies evaluating the cutaneous microbiome using whole genome studies to identify the full microbial community, and identify the role of strain type on risk of invasive infections and the interaction with CTCL severity.
Conclusion: This single location study indicates that though rates of colonization and prevalence of Staphylococcus aureus was similar between white and black patients, Black patients are more likely to become bacteremic as a result of the infection. Although Black patients were more likely to have severe outcomes such as bacteremia, the survival when compared to white patients long term was similar.
