Epidemiology, utilisation of healthcare resources and outcome of invasive fungal diseases following paediatric allogeneic haematopoietic stem cell transplantation.

Publisher: Grosse Verlag Country of Publication: Germany NLM ID: 8805008 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1439-0507 (Electronic) Linking ISSN: 09337407 NLM ISO Abbreviation: Mycoses Subsets: MEDLINE

Original Publication: Berlin : Grosse Verlag, [1988?-

Delivery of Health Care/*statistics & numerical data ; Hematopoietic Stem Cell Transplantation/*adverse effects ; Invasive Fungal Infections/*epidemiology ; Invasive Fungal Infections/*therapy; Adolescent ; Antifungal Agents/therapeutic use ; Child ; Child, Preschool ; Cohort Studies ; Female ; Graft vs Host Disease/diagnosis ; Graft vs Host Disease/epidemiology ; Humans ; Incidence ; Infant ; Invasive Fungal Infections/etiology ; Invasive Fungal Infections/prevention & control ; Male ; Prevalence ; Retrospective Studies ; Risk Factors ; Transplantation, Homologous/adverse effects ; Treatment Outcome ; Young Adult

Background: Epidemiology and management practices of invasive fungal diseases (IFD) after allogeneic haematopoietic stem cell transplantation (HSCT) are a subject of constant change. We investigated the contemporary incidence, diagnostics, antifungal management and outcome at a major paediatric transplant centre in Germany.
Methods: The single-centre retrospective observational study included all paediatric allogeneic HSCT patients (pts) transplanted between 2005 and 2015. Patient-related data were assessed up to 365 days post-transplant. The primary endpoint was the incidence of possible, probable and proven IFDs. Secondary endpoints included diagnostics and antifungal treatment; analysis of risk factors; and overall survival with the last follow-up in January 2017.
Results: A total of 221 first (196), second (21) or third (4) procedures were performed in 200 pts (median age: 9 years, range, 0.5-22) for leukaemia/lymphoma (149) and non-malignant disorders (72). Prophylaxis was administered in 208 HSCT procedures (94%; fluconazole, 116, mould-active agents, 92). At least one computed tomography scan of the chest was performed in 146, and at least one galactomannan antigen assay in 60 procedures. There were 15 cases of proven (candidemia, 4; aspergillosis, 4) or probable (aspergillosis, 7) IFDs, accounting for an incidence rate of 6.8%. Overall mortality at last follow-up was 30%; the occurrence of proven/probable IFDs was associated with a reduced survival probability (P < .001).
Conclusion: Morbidity and mortality from IFDs at our institution were consistent with data reported from other centres. Utilisation of healthcare resources for prevention, diagnosis and management of IFDs was considerable.
(© 2019 The Authors. Mycoses published by Blackwell Verlag GmbH.)

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Keywords: children; diagnostics; management; mycoses; transplantation

0 (Antifungal Agents)

Date Created: 20191030 Date Completed: 20200831 Latest Revision: 20200831

20240829

10.1111/myc.13029

31661569