Invasive fungal infections in pediatric bone marrow transplant recipients: single center experience of 10 years

Abstract

Invasive fungal infections (IFI) with substantial mortality constitute an increasing problem among BMT patients. From 1986 to 1996 148 children underwent BMT, and are included in a retrospective analysis of the incidence, risk factors and outcome of IFI. By histopathology or culture-proven IFI (Candida, 10; Aspergillus, 8) was documented in 12/73 (16%) allogeneic and in 6/75 (8%) autologous BMT patients. Of these 18 patients, 15 subsequently died, and in 12 (66%) IFI was regarded as the main cause of death. In addition to the patients with documented IFI, 48 had suspected and 82 no fungal infection. Invasive candidal infections were more frequent in patients with semiquantitatively estimated abundant candidal colonization as compared with those with no colonization (18% vs 3%, P = 0.015). In the allogeneic group, 50% of those with severe (grades III-IV) aGVHD had IFI as opposed to 8% of those with no or mild aGVHD (P < 0.001). Regarding cGVHD, 57% of those with extensive cGVHD vs 5% of those with absent or limited cGVHD had IFI (P < 0.001). The dose of steroids was associated with IFI: 77% of those who received high-dose steroids (methylprednisolone 0.25-1 g/day for 5 days) vs 5% of those with conventional-dose (prednisone 2 mg/kg/day) had IFI (P < 0.001). Particularly for BMT patients at risk, new, quicker and better diagnostic tests and more effective anti-fungal agents, both for prophylaxis and treatment, are needed.

Predictors of invasive fungal infection in pediatric allogeneic hematopoietic SCT recipients

“…[1][2][3][4][5][6] We may still have underestimated the true incidence of IFI due to a conservative definition of IFI and the fact that autopsy was not always performed. Interestingly, despite changes in our hospital in prophylactic strategies as of 2008 towards the use of more mould-active antifungal agents, the incidence of IFI did not decrease.…”

“…as used in our institution, was based on available literature [1][2][3][4][5][6] and includes pre-and post-HSCT criteria. For this study, we retrospectively classified all patients into high-or low-risk groups using the same criteria.…”

“…[1][2][3][4][5][6] Post-HSCT, GVHD, viral reactivations and use of high-dose steroids are possibly related to the occurrence of IFI. [1][2][3][4][5][6][7][8][9][10] However, studies that focus on pediatric patients are scarce, use relatively small cohorts and are possibly outdated as advances in prophylactic and diagnostic strategies have been made. Therefore, we performed a risk factor analysis on a large cohort of pediatric patients from a single center.…”

“…[1][2][3][4][5][6][7][8][9][10] Based on prior studies, IFI is estimated to occur in 8-17% of pediatric HSCT patients, with a mortality rate of 35-50%. [1][2][3][4][5][6] Incidence varies in the different post-transplant phases, with peaks both pre-and post-engraftment. 7,11 Invasive aspergillosis, invasive candidiasis and zygomycosis are the most common types of IFI.…”

314 Healthcare-Associated Infections in Pediatrics

“…A major problem is treatmentinduced neutropenia, which exposes patients to life-threatening infections. As the intensity of modern cancer chemotherapy has increased, fungal infections have also become more frequent [68]. BSIs, the most prevalent HAIs in pediatric hematology/oncology patients, seem to be associated with the use of a central venous catheter (CVC) in most cases [69,70].…”