title: Invasive fungal infections in pediatric hematopoietic stem cell transplant patients.
abstract: BACKGROUND
  Pediatric hematopoietic stem cell transplant (HSCT) recipients are at high risk of invasive fungal infections (IFIs).
  
  
  METHODS
  To characterize IFIs and changes in fungal organisms over time in pediatric HSCT patients, we performed a retrospective cohort study of all HSCTs performed in pediatric patients at UCLA between 1991 and 2006.
  
  
  RESULTS
  In all, 318 patients underwent 324 HSCT transplants over the 15-year period and 69 unique fungal infections were identified in 47 transplant patients. The overall incidence of fungal infections in HSCT recipients was 14.5%, with predominant organisms including Candida species (51%) and Aspergillus species (26%), with Candida albicans accounting for 18.8% of all fungal species. The distribution of organisms over time demonstrated a strong trend towards an increase in rare molds in more recent years. The respiratory tract was the main site of infection (52.6%), with urine and blood also noted as significant sites. Of all deaths in the patients with IFIs, fungal-related mortality accounted for 67.6% of deaths.
  
  
  CONCLUSIONS
  HSCT patients have a much higher risk of fungal infections with rarer organisms becoming more prevalent, a finding likely linked to evolving antifungal practices over time. This emphasizes the need for the development and implementation of improved diagnostic, prophylactic, and therapeutic strategies to improve patient survival.
authors: From the Department of Pediatrics, Division of Hematology/Oncology, Mattel Children's Hospital at UCLA , Los Angeles, CA , USA.
authors: Tiffany
authors: T
authors: Simms-Waldrip
authors: Galit
authors: G
authors: Rosen
authors: Karin
authors: K
authors: Nielsen-Saines
authors: Alan
authors: A
authors: Ikeda
authors: Berkley
authors: B
authors: Brown
authors: Theodore
authors: T
authors: Moore
mesh_terms: D000293:Adolescent; D000935:Antifungal Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D009181:Mycoses / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D012189:Retrospective Studies
chemical_list: D000935:Antifungal Agents
keywords: Aspergillus; Candida; Fungal infections; HSCT; pediatric; stem cell transplant