title: A prospective, multicentre survey on antifungal therapy in neutropenic paediatric haematology patients.
abstract: Invasive fungal infections are a frequent complication after intensive chemotherapy. The aims of this prospective study were to describe the use of antifungal therapy and to report which strategy was routinely adopted to guide the introduction of antifungal therapy. A total of 321 febrile episodes in 160 paediatric patients affected by acute leukaemia or non-Hodgkin-lymphoma were investigated. Antifungal therapy was used in 100 of 321 febrile episodes (31%), and classified as empiric in 73 episodes, diagnostic-driven in 25 episodes and targeted in 2 episodes. Switching to a second-line antifungal therapy was needed in 28 of 100 episodes (28%) and was classified as empiric in 10 episodes (36%), diagnostic-driven in 17 episodes (61%) and targeted in 1 episode (4%). In 9 of 28 episodes (32%), switching to a third-line antifungal therapy was performed and was classified as empiric in 2 episodes (22%), diagnostic-driven in 6 episodes (67%) and targeted in 1 episode (11%). Invasive fungal infections was reported in 23 of 100 episodes: confirmed in 4 episodes, probable in 8 episodes, and possible in 11 episodes. Attributable mortality was 2.8%. Antifungal therapy was still used mostly empirically, whereas as fever persisted, its modification was guided by a diagnostic-driven approach.
authors.affiliation: Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. simone.cesaro@ospedaleuniverona.it
authors.forename: Simone
authors.initials: S
authors.lastname: Cesaro
authors.forename: Livio
authors.initials: L
authors.lastname: Pagano
authors.forename: Morena
authors.initials: M
authors.lastname: Caira
authors.forename: Francesca
authors.initials: F
authors.lastname: Carraro
authors.forename: Matteo
authors.initials: M
authors.lastname: Luciani
authors.forename: Delia
authors.initials: D
authors.lastname: Russo
authors.forename: Antonella
authors.initials: A
authors.lastname: Colombini
authors.forename: William
authors.initials: W
authors.lastname: Morello
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Viale
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rossi
authors.forename: Gloria
authors.initials: G
authors.lastname: Tridello
authors.forename: Anna
authors.initials: A
authors.lastname: Pegoraro
authors.forename: Annamaria
authors.initials: A
authors.lastname: Nosari
authors.forename: Franco
authors.initials: F
authors.lastname: Aversa
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000935:Antifungal Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000150:complications*; D008228:Lymphoma, Non-Hodgkin / Q000150:complications*; D008297:Male; D009503:Neutropenia / Q000188:drug therapy*; D011446:Prospective Studies
chemical_list: D000935:Antifungal Agents