Prevalence of Colonization, Association With Disease Stage and Effect of Eradication of Staphylococcus aureus in Cutaneous T-Cell Lymphoma: A Systematic Review and Meta-Analysis

Background: Cutaneous T-cell lymphoma (CTCL) is a rare and heterogeneous group of skin-homing lymphomas with a largely unknown pathogenesis. Staphylococcus aureus (S. aureus) colonization has been implicated in exacerbating CTCL, particularly in advanced stages. Objectives: This study assessed the prevalence of S. aureus colonization in CTCL through a systematic review and meta-analysis, exploring the association with disease stage and evaluating the effect of antibiotic therapy. Methods: We conducted a systematic review and meta-analysis according to the PRISMA guidelines. The databases PubMed, Embase, Cochrane Library and Web of Science were searched in April 2024. Studies containing data on the association between S. aureus and CTCL were included. We calculated the pooled point prevalence of S. aureus and MRSA and the odds ratio (OR) of infection and disease stage. Secondary, the occurrence of colonization in lesional versus non-lesional skin and effects of decolonization with antibiotics were reviewed. Results: Thirteen studies were included. The pooled point prevalence of S. aureus and MRSA was 39.84% (26.72%–54.61%, I² = 93%, p < 0.01) and 30.43% (9.38%–64.88%, I² = 81%, p < 0.01). The pooled point OR of systemic bacterial infection and disease-stage was estimated to 1.36 (0.74; 2.522, I² = 20%, p = 0.29). Furthermore, a higher abundance of S. aureus was found in lesional skin compared to non-lesional skin and a partial or complete response in body surface area (BSA) was observed after antibiotic-induced eradication of culture-proven S. aureus colonization. Conclusions: S. aureus colonization is common in CTCL patients, with increased presence in lesional skin. Despite no significant association between infection and disease stage, there was a tendency for higher occurrence of S. aureus in lesional skin. Antibiotic therapy may reduce disease activity, but the temporary effects of antibiotics and the rising challenge of MRSA emphasize the need for non-antibiotic treatment approaches to manage CTCL effectively.