title: Bacteremia during neutropenia is a predictive factor for invasive fungal infection in children.
abstract: BACKGROUND
  Invasive fungal infection (IFI) is a critical complication in the management of hematologic and malignant disease. Given that there is a tendency for IFI to occur after bacteremia following febrile episodes during neutropenia, the aim of this study was to determine if bacteremia was a predictive factor for IFI in pediatric patients with hematologic and malignant disease.
  
  
  METHODS
  Sixty-two patients (32 boys, 30 girls; median age, 4 years) with hematologic or malignant disease who had received chemotherapy, immunosuppressive therapy, and/or hematopoietic stem cell transplantation, and experienced febrile episodes during neutropenia were enrolled. In patient-based analysis, clinical features of 62 patients were compared between those with and without IFI. Meanwhile, in febrile episode-based analysis, clinical features were analyzed for 268 febrile episodes occurring during neutropenia in the 62 patients.
  
  
  RESULTS
  Patient-based analysis showed that relapse of original disease and acute myeloid leukemia were risk factors for IFI. Meanwhile, febrile episode-based analysis identified bacteremia following febrile episodes during neutropenia as a potential risk factor for IFI.
  
  
  CONCLUSIONS
  This is the first report to identify bacteremia following febrile episodes during neutropenia as a predictive factor for IFI in pediatric patients with hematologic or malignant disease. When bacteremia is detected in such patients, sufficient preventive measures against IFI, including intensive use of antifungal agents, are warranted.
authors.affiliation: Department of Pediatrics, Sapporo Hokuyu Hospital, Sapporo, Japan. hirozumi.sano@gmail.com
authors.forename: Hirozumi
authors.initials: H
authors.lastname: Sano
authors.forename: Ryoji
authors.initials: R
authors.lastname: Kobayashi
authors.forename: Daisuke
authors.initials: D
authors.lastname: Suzuki
authors.forename: Kenji
authors.initials: K
authors.lastname: Kishimoto
authors.forename: Kazue
authors.initials: K
authors.lastname: Yasuda
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Kobayashi
mesh_terms: D016470:Bacteremia / Q000209:etiology*; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000009:adverse effects; D005260:Female; D006402:Hematologic Diseases / Q000150:complications / Q000628:therapy; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D009181:Mycoses / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D009369:Neoplasms / Q000150:complications / Q000628:therapy; D009503:Neutropenia / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends