Fungal Infections in Children With Cancer

Castagnola, Elio; Cesaro, Simone; Giacchino, M; Livadiotti, Susanna; Tucci, Fábio C.; Zanazzo, Giulio Andrea; Caselli, D; Caviglia, Ilaria; Parodi, Stefano; Rondelli, Roberto; Cornelli, Pier Emilo; Mura, Rossella; Santoro, Nicola; Russo, Giovanna; Santis, Raffaella De; Buffardi, Salvatore; Viscoli, Claudio; Haupt, Riccardo; Rossi, Mario

doi:10.1097/01.inf.0000220256.69385.2e

Cited by 136 publications

(31 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This was particularly true for adenovirus (42% mortality) and herpes viruses such as CMV (32% mortality) and may relate to antiviral resistance or high rates of T-cell immune incompetence secondary to the intensity of the conditioning, use of serotherapy, underlying disease, and processing, such as T-cell depletion (43). Consistent with the literature, fungal infections had a strong association with mortality, although our finding of 33.7% mortality in fungal infections is lower than recent mortality reports of 41–58% in this population (44–47) and may suggest improvement from new antifungal agents and diagnostic tests (44). These results also show that hematologic cancer patients and PID patients have different infection patterns posttransplant, with hematologic patients at higher risk for fungal infections and PID patients at higher risk for Gram-negative and viral infections.…”

Section: Discussionsupporting

confidence: 89%

New Insights Into Multicenter PICU Mortality Among Pediatric Hematopoietic Stem Cell Transplant Patients*

Zinter

Dvorak

Spicer

et al. 2015

Critical Care Medicine

View full text Add to dashboard Cite

Objectives Over 2,500 children undergo hematopoietic stem cell transplantation in the United States each year, and up to 35% require PICU support for life-threatening complications. PICU mortality has dropped from 85% to 44%, but interpretation is confounded by significant cohort heterogeneity. Reports conflict regarding outcomes for patients with different underlying hematopoietic stem cell transplantation indications, and the burden of infectious complications for these patients has not been evaluated. We aim to describe infections, critical care interventions, and mortality for pediatric hematopoietic stem cell transplantation patients requiring PICU admission. Design A retrospective multicenter cohort analysis. Setting One hundred twelve centers in the Virtual PICU Systems database, January 1, 2009, to June 30, 2012. Patients A total of 1,782 admissions for patients who are 21 years old or younger with prior hematopoietic stem cell transplantation. Interventions None. Measurements and Main Results Pediatric Index of Mortality-2, Pediatric Risk of Mortality-3, transplant indication, infections, interventions, and mortality were recorded from admission through PICU death or discharge. Pediatric hematopoietic stem cell transplantation patients comprised 0.7% of all PICU admissions (1,782/246,346), which resulted in 16.2% mortality compared with 2.4% mortality for non-hematopoietic stem cell transplantation admissions (odds ratio, 7.8; 95% CI, 6.8–8.8; p < 0.001). Mortality for admissions with underlying hematologic malignancy (22.7%) was similar to that of admissions with primary immunodeficiency (19.4%; p = 0.41) but significantly greater than admissions with underlying nonmalignant non-primary immunodeficiency hematologic disease (15.4%; p = 0.020), metabolic disorder (8.1%; p < 0.001), or solid malignancy (5.7%; p < 0.001). Infection was documented in 45.7% of admissions with 22.2% mortality; viral and fungal mortality were 28.5% and 33.7%, respectively. Invasive positive pressure ventilation and renal replacement therapy were used in only 34.6% and 11.9% of admissions, with mortality of 42.5% and 51.9%, respectively. Conclusions PICU mortality for pediatric hematopoietic stem cell transplantation patients may be as low as 16.2% but higher for those receiving intubation (42.5%) or replacement therapy (51.9%). Hematologic malignancy and primary immunodeficiency had greater risk for mortality than other transplant indications. Greater understanding of other risk factors affecting mortality and the need for critical care support is needed.

show abstract

Section: Discussionsupporting

confidence: 89%

New Insights Into Multicenter PICU Mortality Among Pediatric Hematopoietic Stem Cell Transplant Patients*

Zinter

Dvorak

Spicer

et al. 2015

Critical Care Medicine

View full text Add to dashboard Cite

show abstract

“…The incidence of invasive fungal infection in pediatric allogeneic HSCT recipients is reported to be 1.3-13% for Candida infection and 3-14% for mold infection, while, the incidence is 5-6% for Candida infection and 0.3-3% mold infection in autologous HSCT recipients 17,20-25. Nationwide data of 152,231 immunocompromised children in the United States, including 822 autologous HSCT recipients, show that 0.3% of autologous HSCT recipients had invasive aspergillosis 17.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Itraconazole Prophylaxis for Autologous Stem Cell Transplantation in Children with High-Risk Solid Tumors: A Prospective Double-Blind Randomized Study

et al. 2011

View full text Add to dashboard Cite

PurposeThe risk of invasive fungal infection is greater for allogeneic hematopoietic stem cell transplantation (HSCT) than for autologous transplantation. Therefore, many transplantation centers use antifungal prophylaxis for allogeneic HSCT, however, there exists no standard guidelines or consensus regarding autologous HSCT.Materials and MethodsA prospective double-blind randomized study was conducted in autologous HSCT recipients who were divided into prophylaxis and empirical treatment groups, and we investigated the efficacy of itraconazole prophylaxis in pediatric autologous HSCT.ResultsTotal 87 autologous HSCT episodes in 55 children with high-risk solid tumors were studied. No invasive fungal infections occurred in either group. However, patients in the prophylaxis group had a significantly shorter duration of fever (p < 0.05) and received antibacterial treatment of shorter duration (p < 0.05) with fewer numbers of antibiotics (p < 0.05 for the use of second line antibiotics) than those in the empirical group. No significant additional adverse events were found with itraconazole prophylaxis.ConclusionAlthough beneficial effects such as a shorter duration of fever and reduced need for antibiotic use were observed in the prophylaxis group, the results were not sufficient to draw a definite recommendation about the routine use of antifungal prophylaxis in pediatric autologous HSCT recipients with high-risk solid tumors (Trial registration: NCT00336531).

show abstract

“…Welldesigned prospective PK-PD studies in clinical settings, in conjunction with modeling and simulation based on preclinical data, are the best tools for establishing equivalent evidence-based optimal dosing regimens for these older agents (32). As in previous observational studies, systemic antifungals were most frequently prescribed for the prevention and treatment of IFI in immunosuppressed children and preterm neonates (33)(34)(35). Indication-specific dosing was recently described for fluconazole use in neonates.…”

Section: Discussionmentioning

confidence: 99%

Systemic Antifungal Prescribing in Neonates and Children: Outcomes from the Antibiotic Resistance and Prescribing in European Children (ARPEC) Study

Lestner

Versporten

Doerholt

et al. 2015

Antimicrob Agents Chemother

View full text Add to dashboard Cite

The appropriate use of systemic antifungals is vital in the prevention and treatment of invasive fungal infection (IFI) in immunosuppressed children and neonates. This multicenter observational study describes the inpatient prescribing practice of antifungal drugs for children and neonates and identifies factors associated with prescribing variability. A single-day point prevalence study of antimicrobial use in hospitalized neonates and children was performed between October and December 2012. The data were entered through a study-specific Web-based portal using a standardized data entry protocol.

show abstract

Fungal Infections in Children With Cancer

Cited by 136 publications

References 52 publications

New Insights Into Multicenter PICU Mortality Among Pediatric Hematopoietic Stem Cell Transplant Patients*

New Insights Into Multicenter PICU Mortality Among Pediatric Hematopoietic Stem Cell Transplant Patients*

Efficacy of Itraconazole Prophylaxis for Autologous Stem Cell Transplantation in Children with High-Risk Solid Tumors: A Prospective Double-Blind Randomized Study

Systemic Antifungal Prescribing in Neonates and Children: Outcomes from the Antibiotic Resistance and Prescribing in European Children (ARPEC) Study

Contact Info

Product

Resources

About