title: Voriconazole prophylaxis in children with cancer: changing outcomes and epidemiology of fungal infections.
abstract: BACKGROUND
  Invasive mould infections are a significant cause of morbidity and mortality in pediatric cancer patients, particularly in those undergoing aggressive myeloablative chemotherapy. Voriconazole has been described as an appropriate and effective prophylactic agent in adults with cancer.
  
  
  METHODS
  We compared the etiology, predisposing factors and outcomes of invasive mould infection in patients treated for acute myeloid leukemia before and after implementation of voriconazole prophylaxis in a pediatric cancer center.
  
  
  RESULTS
  We observed no difference in the number of invasive mould infection between groups. However, isolated organisms were markedly different, with a shift from aspergillosis to phaeohyphomycosis after the implementation of voriconazole prophylaxis. Survival at 90 days was improved in patients receiving voriconazole prophylaxis (P = 0.05). We did not identify a significant increase in the incidence of zygomycosis associated with routine use of voriconazole prophylaxis.
  
  
  CONCLUSIONS
  Voriconazole prophylaxis was associated with improved survival in pediatric patients with acute myeloid leukemia, although other factors may be involved. Voriconazole prophylaxis was associated with a marked change in the pattern of mould infections, with a significant reduction in aspergillosis.
authors.affiliation: From the Departments of *Infectious Diseases, †Pathology, and ‡Oncology, St. Jude Children's Research Hospital; and Departments of §Pediatrics and ¶Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Gabriela M
authors.initials: GM
authors.lastname: Maron
authors.forename: Randall T
authors.initials: RT
authors.lastname: Hayden
authors.forename: Alicia
authors.initials: A
authors.lastname: Rodriguez
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Rubnitz
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Flynn
authors.forename: Jerry L
authors.initials: JL
authors.lastname: Shenep
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Knapp
mesh_terms: D000293:Adolescent; D000328:Adult; D019072:Antibiotic Prophylaxis; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000453:epidemiology / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D015470:Leukemia, Myeloid, Acute / Q000453:epidemiology* / Q000382:microbiology; D008297:Male; D009181:Mycoses / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D016896:Treatment Outcome; D065819:Voriconazole / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D065819:Voriconazole