Risks, diagnosis and outcomes of invasive fungal infections in haematopoietic stem cell transplant recipients

Barnes, Penelope D.; Marr, Kieren A.

doi:10.1111/j.1365-2141.2007.06812.x

Cited by 141 publications

(94 citation statements)

References 105 publications

(174 reference statements)

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“…Possible causes may be the increasing percentage of high-risk patients being transplanted over the last few years (the proportion of patients with a TRM risk 420% rose from 40 to 60%; data not shown), increasing patient age and better diagnostic tools to identify IFI. 10 Moreover, the increasing incidence of azole-resistant IFI as described by Snelders et al 20 may partly explain the less than optimal effectivity of our prophylactic strategy. Patients who were classified into the 'low-risk' group, rarely developed IFI, showing that risk group stratification for developing IFI using criteria based on available literature seems to correlate well with the actual occurrence of IFI.…”

Section: Discussionmentioning

confidence: 84%

“…[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.…”

Section: Introductionmentioning

confidence: 99%

“…[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However, studies that focus on pediatric patients are scarce, use relatively small cohorts and are possibly outdated as advances in prophylactic and diagnostic strategies have been made.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.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of invasive fungal infection in pediatric allogeneic hematopoietic SCT recipients

Hol

Wolfs

Bierings

et al. 2013

Bone Marrow Transplant

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This study was aimed at finding predictors of invasive fungal infection (IFI) after pediatric allogeneic hematopoietic SCT (HSCT). All children who received allogeneic HSCT in the Wilhelmina Children's Hospital Utrecht between 2004 and 2012 were included. HSCT data were prospectively collected. Patients were retrospectively classified into high-or low-risk groups for developing IFI using criteria based on available literature. Predictors for the occurrence of IFI were analyzed using Cox regression models. We used logistic regression models to analyze the association between other HSCT-related complications and IFI. Secondary outcomes were overall survival and treatment-related mortality (TRM). Two-hundred nine patients were included in the analysis; median age was 6.6 years. The cumulative incidence of IFI was 12%. In patients classified as 'low risk' (n ¼ 75), only 5.3% developed IFI (odds ratio (OR): 0.325; P ¼ 0.047). In multivariate analysis, a predictor for the occurrence of IFI was an a priori determined HSCT TRM risk 420% (based on EBMT-risk score). Post-HSCT, the administration of high-dose steroids was associated with IFI (OR: 4.458; P ¼ 0.010). Patients who developed IFI showed an increased risk of TRM (OR: 3.773; P ¼ 0.004). These results confirm that risk group stratification should guide intensity of monitoring for IFI and use of antifungal prophylaxis.

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Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictors of invasive fungal infection in pediatric allogeneic hematopoietic SCT recipients

Hol

Wolfs

Bierings

et al. 2013

Bone Marrow Transplant

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“…), foreign objects (notably blood and urinary catheters), as well as the presence of fungi in the environment (Aspergillus and work). [1,2] In patients with hematological malignancies, the incidence of invasive fungal infections (IFIs) has increased regularly during the last decade. The majority of these infections occur in patients with acute myeloid leukemia or myelodysplastic syndrome (MDS) or in those who have received allogenic hematopoietic stem cell transplants.…”

Section: What This Study Adds To the Fieldmentioning

confidence: 99%

Impact of fluconazole versus posaconazole prophylaxis on the incidence of fungal infections in patients receiving induction chemotherapy for acute myeloid leukemia

et al. 2015

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F ungal infections are related to human communal agents or to environmental saprophytes and are rare in healthy subjects. Known contributing factors are reduced defense mechanisms of the host, the use of certain Background: Invasive fungal infections (IFIs) remain one of the worrying complications in patients with acute myeloid leukemia (AML) due to their incidence and high level of attributable mortality. In light of these risks, antifungal prophylaxis has always been debated. We conducted a single-center retrospective study of two prophylactic antifungal agents (fluconazole/posaconazole) in 91 consecutive patients receiving induction chemotherapy for AML between 2005 and 2009, in order to evaluate the impact on the incidence of IFI and on the mycological flora of the patients. Methods:In total, 39 patients received prophylactic fluconazole versus 52 who received posaconazole. The baseline characteristics of the two groups were comparable. Results:Overall, 17 patients developed an IFI, with no difference in frequency between the two groups. Utilization of empirical or pre-emptive therapy was similar irrespective of the type of prophylaxis used. Mycological examination of stools revealed an increase in non-albicans Candida colonization in the fluconazole group during hospitalization and the appearance of Saccharomyces cerevisiae colonization in patients receiving posaconazole. Conclusion: The present study does no t distinguish between fluconazole and posaconazole as a primary effective prevention against fungal infections. More prospective studies and meta-analyses are warranted. (Biomed J 2015;38:235-243)

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“…Los factores de riesgo identificados para infección por Candida spp. en el primer período post-TPH son la profundidad de la neutropenia, la presencia de mucositis y el uso de CVC, agregándose en el segundo período post-trasplante la presencia de EICH intestinal 41 .…”

Section: Trasplante De Precursores Hematopoyéticosunclassified

Profilaxis antifúngica en niños y adultos sometidos a trasplante de órganos sólidos y de precursores hematopoyéticos

Rabagliati¹,

Santolaya²

2012

Rev. chil. infectol.

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Prophylaxis against fungal infections in solid organ and hematopoietic stem cells transplantationInvasive fungal infections are an important cause of morbidity and mortality in SOT and HSCT recipients. The main species involved are Candida spp. and Aspergillus spp, less frequently Cryptococcus spp., causal agents of mucormycosis and Fusarium spp. Usually occur within the first six months post-transplant, but they do it later, especially during episodes of rejection, which maintains the state of immune system involvement. Prophylaxis recommendations are specific to each type of transplant. In liver transplantation use of fluconazole is recommended only in selected cases by high risk factor for invasive fungal infections (A1). If the patient has a high risk of aspergillosis, there are some suggestions for adults population to use amphotericin B-deoxycholate, liposomal amphotericin B or caspofungin (C2) without being validated none of these recommendations in pediatric population. In adult lung transplant patients where the risk of aspergillosis is higher than in other locations, we recommend universal prophylaxis with itraconazole 200 mg/day, nebulised liposomal amphotericin B or voriconazole (C2), no validated recommendations for pediatrics. In HSCT, universal prophylaxis is recommended only in allogeneic and autologous selected cases. The most accepted indication is fluconazole (A1), and posaconazole (A1) or micafungin (A1) in selected cases with high risk of aspergillosis.Key words: Fungus, Candida, Aspergillus, yeasts, moulds, prophylaxis, amphotericin, fl uconazole, voriconaamphotericin, fluconazole, voriconazole, posaconazole, caspofungin, micafungin, transplants, solid organ transplantation, hematopoietic stem cells transplantation.Palabras clave: Hongos, Candida, Aspergillus, levaduras, hongos filamentosos, profilaxis, anfotericina, fluconazol, voriconazol, posaconazol, caspofungina, micafungina, trasplante, trasplante de órganos sólidos, trasplante de precursores hematopoyéticos. IntroducciónL as infecciones fúngicas constituyen una importante causa de morbilidad en los pacientes receptores de trasplantes de órganos sólidos (TOS) y trasplante de precursores hematopoyéticos (TPH) 1 , generando desafíos diagnósticos y terapéuticos, elevación de los costos de manejo y elevada mortalidad 2,3 . En los receptores de trasplantes, la enfermedad fúngica invasora (EFI) es provocada tanto por hongos levaduriformes como filamentosos, destacando Candida spp. y Aspergillus spp. 2-4 , menos frecuentemente Cryptococcus spp., agentes causales de mucormicosis 5,6 y Fusarium spp. 7 , infecciones por hongos endémicos como Histoplasma capsulatum, Coccidioides immitis, Paracoccidioides brasiliensis, y con menor cuantía dematiáceos como Cladosporium, Cladophialophora, Scopulariopsis, Alternaria, Curvularia y Bipolaris spp 8 .Existen diferencias en la frecuencia de EFI entre los distintos tipos de TOS y TPH; no obstante, algunas características son comunes: en ambos grupos la mayoría de las EFI son producidas por Candida spp. o ...

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Risks, diagnosis and outcomes of invasive fungal infections in haematopoietic stem cell transplant recipients

Cited by 141 publications

References 105 publications

Predictors of invasive fungal infection in pediatric allogeneic hematopoietic SCT recipients

Predictors of invasive fungal infection in pediatric allogeneic hematopoietic SCT recipients

Impact of fluconazole versus posaconazole prophylaxis on the incidence of fungal infections in patients receiving induction chemotherapy for acute myeloid leukemia

Profilaxis antifúngica en niños y adultos sometidos a trasplante de órganos sólidos y de precursores hematopoyéticos

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