Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611-2941, USA.
J Natl Cancer Inst. 2010 Jan 6;102(1):47-53. doi: 10.1093/jnci/djp439. Epub 2009 Dec 9.
Patients treated with epidermal growth factor receptor inhibitors (EGFRIs) frequently experience dermatologic toxic effects. Whereas the impact of these effects on quality of life and EGFRI dosing has been described, their impact on physical health has not been ascertained. We examined the prevalence of infections that complicate dermatologic toxic effects of EGFRIs.
We used retrospective chart review methods to analyze 221 patients who were treated in the Skin and Eye Reactions to Inhibitors of EGFR and Kinases clinic, a referral clinic for dermatologic toxic effects of cancer therapies. We reviewed results of bacterial cultures, histopathologic assessment of biopsy samples, and immunohistochemical staining of skin specimens for viral pathogens that were recorded in the patients' medical records. Associations between patient demographic and treatment characteristics and the development of infections were examined using the Fisher exact test. All statistical tests were two-sided.
Eighty-four (38%) of the 221 patients showed evidence of infection at sites of dermatologic toxic effect. Fifty (22.6%) of the 221 patients had cultures positive for Staphylococcus aureus, and 12 (5.4%) of the 221 patients cultured positive for methicillin-resistant S aureus. Less frequent infections included herpes simplex (3.2%), herpes zoster (1.8%), and dermatophytes (10.4%). The seborrheic region was the most prevalent site of infection, and patients with leukopenia had higher risk for infection than patients who did not have leukopenia (P = .005). Demographic factors and associated treatments were not associated with the occurrence of a dermatologic infection (P > or = .05).
Patients with dermatologic toxic effects following treatment with EGFRIs have a high prevalence of cutaneous infections. Most notably, bacterial infections developed at sites previously affected by dermatologic toxic effects, with leukopenic patients being at greater risk.
接受表皮生长因子受体抑制剂（EGFRIs）治疗的患者常出现皮肤毒性作用。虽然这些作用对生活质量和 EGFRIs 剂量的影响已有描述，但它们对身体健康的影响尚未确定。我们检查了皮肤毒性作用的 EGFRIs 并发症感染的发生率。
我们使用回顾性图表审查方法分析了 221 例在皮肤和眼部反应到 EGFR 和激酶抑制剂的诊所就诊的患者，这是一个癌症治疗皮肤毒性作用的转诊诊所。我们分析了患者病历中记录的细菌培养、活检样本的组织病理学评估以及皮肤标本的病毒病原体免疫组织化学染色的结果。使用 Fisher 确切检验检验患者人口统计学和治疗特征与感染发展之间的关联。所有统计检验均为双侧。
221 例患者中有 84 例（38%）显示皮肤毒性作用部位有感染证据。221 例患者中有 50 例（22.6%）培养出金黄色葡萄球菌阳性，221 例患者中有 12 例（5.4%）培养出耐甲氧西林金黄色葡萄球菌阳性。较不常见的感染包括单纯疱疹（3.2%）、带状疱疹（1.8%）和皮肤真菌（10.4%）。脂溢部位是最常见的感染部位，白细胞减少症患者的感染风险高于无白细胞减少症患者（P =.005）。人口统计学因素和相关治疗与皮肤感染的发生无关（P >或=.05）。
接受 EGFRIs 治疗后出现皮肤毒性作用的患者皮肤感染发生率较高。最值得注意的是，细菌感染发生在以前受皮肤毒性作用影响的部位，白细胞减少症患者的风险更高。
