Retrospective analysis of yeast colonization and infections in paediatric bone marrow transplant recipients.
Sixty-four paediatric patients who underwent allogeneic (n = 35), autologous (n = 28) or syngeneic (n = 1) bone marrow transplantation (BMT) between 1992 and 1994 were evaluated retrospectively. As antifungal prophylaxis, all patients received amphotericin B tablets and 62 of 64 (96.9%) received oral fluconazole. Weekly surveillance cultures revealed fungal colonization in 35 patients (54.7%). Six patients (9.4%) were colonized before BMT only, 17 (26.6%) after BMT only and 12 (18.8%) both before and after BMT. Candida albicans was the most frequently isolated fungus [21 of 46 fungal isolates (45.7%)], followed by C. glabrata [14 isolates (30.4%)]. Non-albicans species of Candida were most frequently isolated after BMT from the faeces, often in high numbers. Autologous marrow recipients had a higher fungal colonization rate both before and after BMT than allogeneic marrow recipients. One patient suffered from invasive pulmonary aspergillosis after BMT. No fungaemias or deep-seated yeast infections were observed. Six of the seven patients who had to be treated with intravenous amphotericin B because of antibiotic-refractory fever had undergone autologous BMT. Multivariate analysis of various parameters showed only pre-BMT yeast colonization to be independently associated with post-BMT colonization. Thus, systemic mycoses occurred only rarely in this study population; however yeast colonization after BMT (especially with non-albicans species) was a frequent event in spite of double prophylaxis with oral amphotericin B and fluconazole.
Hoppe
J E
JE
University Children's Hospital, Tübingen, Germany.
Klausner
M
M
Klingebiel
T
T
Niethammer
D
D
D000293:Adolescent; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000704:Analysis of Variance; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy / Q000453:epidemiology; D016026:Bone Marrow Transplantation; D002175:Candida / Q000302:isolation & purification*; D002177:Candidiasis / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009181:Mycoses / Q000453:epidemiology* / Q000517:prevention & control; D011183:Postoperative Complications; D012189:Retrospective Studies; D012441:Saccharomyces cerevisiae / Q000302:isolation & purification; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D014185:Transplantation, Isogeneic
D000935:Antifungal Agents; D000666:Amphotericin B