Microbiologically documented fungal infections in pediatric patients with acute myeloid leukemia: 12.5-year experience at a single institution.
The primary objective of this study was to determine the incidence and types of microbiologically documented fungal infections in 56 children with acute myeloid leukemia admitted to Wolfson Children's Hospital. The secondary objective was to determine the factors that may affect the treatment and outcome of these infections, such as antifungal prophylaxis, absolute neutrophil count, age, and phase of therapy. Medical records were reviewed from January 1, 2000 to July 31, 2012. Over the 12.5-year study period, there were 11 patients with 25 episodes of fungal infections. Adolescents with acute myeloid leukemia (13 to 18 y old) represented 48% of the population. Children less than 3 years of age and between 3 and 12 years of age represented one quarter each. None of the patients less than 3 years of age developed fungal infections, whereas 64% of the adolescents did (P=0.01). Blood-borne infections were the most common site of infection (44%). Eighty-four percent of infections occurred in neutropenic patients. The mortality rate in the overall cohort was 28%. Patients with fungal infections had increased mortality rate of 55%. Overall candidiasis and aspergillosis were the major pathogens (28% each), although there have been no occurrences of Aspergillus sp. since 2005. On the basis of the results of our study, it would be prudent to provide antifungal coverage for both these pathogens, such as with voriconazole or echinocandins over fluconazole.
*Department of Pediatrics, College of Medicine, University of Florida †Department of Hematology/Oncology, Nemours Children's Clinic, Jacksonville, FL.
Vibhuti
V
Agarwal
Michael
M
Joyce
D000293:Adolescent; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000401:mortality / Q000517:prevention & control*; D002177:Candidiasis / Q000401:mortality / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D016469:Fungemia / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015470:Leukemia, Myeloid, Acute / Q000382:microbiology* / Q000401:mortality; D009026:Mortality; D009503:Neutropenia / Q000401:mortality; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D060586:Trichosporonosis / Q000401:mortality / Q000517:prevention & control*
D000935:Antifungal Agents