title: Invasive fungal infections in pediatric patients with hematologic malignancies receiving oral amphotericin B solution and early intravenous administration of fluconazole.
abstract: This study aimed to determine the frequency of invasive fungal infection (IFI) in pediatric patients with hematologic malignancy who received amphotericin B oral suspension and early intravenous fluconazole during the neutropenic phase as prophylaxis for IFI. Records of 743 neutropenic episodes induced by cytotoxic chemotherapy between 1997 and 2008 were retrospectively reviewed to determine risk factors for and frequency of IFI. The overall frequency of IFI was 0.8% (n=6) and frequencies of proven, probable, and possible infections were 0.3% (n=2), 0.4% (n=3), and 0.1% (n=1), respectively. During 351 episodes of profound neutropenia (neutrophil count <500/μL for ≥ 14 d), overall incidence of IFI was 1.71% (n=6). Pulmonary aspergillosis was the most common causative agent, and no patients showed candidemia, or hepatosplenic candidiasis. Cytotoxic chemotherapy regimens for acute myelogenous leukemia and profound neutropenia were significantly associated with IFI (P=0.004 and P=0.009, respectively). No IFI-attributable deaths or breakthrough fungal infections occurred. Our results indicate that amphotericin B oral solution and early intravenous fluconazole may be effective in reducing the incidence and mortality of IFI in pediatric patients with hematologic malignancies.
authors.affiliation: Division of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan. nobuhiro.watanabe@sch.pref.shizuoka.jp
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Watanabe
authors.forename: Kimikazu
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Seiji
authors.initials: S
authors.lastname: Kojima
authors.forename: Koji
authors.initials: K
authors.lastname: Kato
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000666:Amphotericin B / Q000008:administration & dosage*; D000935:Antifungal Agents / Q000008:administration & dosage*; D000970:Antineoplastic Agents / Q000009:adverse effects; D001228:Aspergillosis / Q000188:drug therapy / Q000276:immunology / Q000401:mortality; D002177:Candidiasis / Q000188:drug therapy / Q000276:immunology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage*; D006801:Humans; D015994:Incidence; D007223:Infant; D007262:Infusions, Intravenous; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000276:immunology / Q000401:mortality*; D008297:Male; D009503:Neutropenia / Q000139:chemically induced / Q000276:immunology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D000970:Antineoplastic Agents; D000666:Amphotericin B; D015725:Fluconazole