TOPLINE

Skin involvement occurred in more than 20% of neutropenic patients with hematologic malignancies who developed a Pseudomonas aeruginosa bloodstream infection (PA-BSI), and acute myeloid leukemia (AML) and recurrent PA-BSI were independent risk factors. Patients with skin lesions experienced a longer duration of neutropenia and hospitalization.

METHODOLOGY

• Researchers conducted a single-center, retrospective cohort study to determine factors associated with skin involvement among neutropenic patients with hematologic malignancies who developed PA-BSI between April 2003 and April 2023.
• They identified 142 patients (median age at diagnosis, 56 years) from the Cologne Cohort of Neutropenic Patients database; 44.4% of patients had AML, 18.3% had non-Hodgkin lymphoma, and 9.9% had acute lymphoblastic leukemia.
• Skin involvement was defined as secondary cutaneous lesions documented after the onset of PA-BSI, including classic ecthyma gangrenosum, necrotic cutaneous nodules, cellulitis, and other skin lesions, with or without a wound swab confirmation of P aeruginosa.
• The primary outcome was the presence of skin involvement; secondary outcomes included duration of neutropenia, length of hospital stay, and 28-day mortality.

TAKEAWAY

• Skin involvement was present in 21.1% of patients.
• Patients with skin involvement had a significantly longer median duration of neutropenia (27 vs 16 days; P = .022) and hospital stay (47.5 vs 36.5 days; P = .017) than those without skin involvement.
• The 28-day mortality rate was 22.5%. Mortality rates were similar between patients with and without skin involvement.
• In the multivariate analysis, AML was independently associated with increased risk for skin involvement (odds ratio [OR], 3.430; P = .023), as was recurrent PA-BSI (OR, 6.168; P = .005). However, cardiovascular disease was associated with a lower risk for skin involvement (OR, 0.359; P = .031).

IN PRACTICE

"The strong association of recurrent PA-BSI with skin involvement highlights the importance of infection prevention measures, including evaluation and timely catheter change," the study authors wrote. "Future multicenter prospective studies are needed to confirm these findings and to further elucidate the host and pathogen factors predisposing to skin involvement in neutropenic patients with PA-BSI."

SOURCE

The study was led by Dominic Rauschning, University Hospital Cologne, Cologne, Germany. It was published online as a Research Note on August 26, 2026, in Clinical Microbiology and Infection.

LIMITATIONS

The retrospective, single-center design might have introduced reporting bias and limited generalizability. The limited number of patients with skin involvement might have prevented the identification of additional associated factors. Changing treatment standards over the 20-year study period might have influenced outcomes.

DISCLOSURES

The study received no additional funding beyond routine salaries. One author reported receiving grants from the German Research Foundation, German Federal Ministry of Education and Research, and European Union Horizon 2020 as well as honoraria from multiple pharmaceutical companies. Another author reported receiving funding from the German Federal Ministry of Education and Research, European Union Horizon 2020, and other sources as well as honoraria from several pharmaceutical companies. Full disclosures are reported in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.