Invasive Fungal Infections in Immunocompromised Children: Novel Insight Following a National Study.

Autor: Olivier-Gougenheim L; Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, University Lyon 1, Lyon, France. Electronic address: olivier_laura@hotmail.fr., Rama N; Apoptosis, Cancer and Development Laboratory, INSERM U1052, CNRS UMR5286, CRCL, Lyon, France., Dupont D; Institut des Agents Infectieux, Parasitology-Mycology Unit, Lyon, France., Saultier P; Pediatric Hematology-OncologyUnit, CHU Marseille, Marseille, France., Leverger G; Pediatric Hematology-Oncology Unit, AP-HP Trousseau, Paris, France., AbouChahla W; Pediatric Hematology Unit, CHU Lille, Lille, France., Paillard C; Pediatric Hematology-Oncology Unit, CHU Strasbourg, Strasbourg, France., Gandemer V; Pediatric Hematology-OncologyUnit, CHU Rennes, Rennes, France., Theron A; Pediatric Hematology-Oncology Unit, CHU Montpellier, Montpellier, France., Freycon C; Pediatric Hematology-Oncology Unit, CHU Grenoble, Grenoble, France., Pluchart C; Pediatric Hematology-Oncology Unit, Institut Jean Godinot, CHU Reims, Reims, France., Blouin P; Pediatric Hematology-Oncology Unit, CHU Tours, Tours, France., Pellier I; Pediatric Hematology-Oncology Unit, CHU Angers, Angers, France., Thouvenin-Doulet S; Pediatric Hematology-Oncology Unit, CHU St-Etienne, Saint-Etienne, France., Desplantes C; Pediatric Hematology-Oncology Unit, CHU Dijon, Dijon, France., Ducassou S; Pediatric Hematology-Oncology Unit, CHU Bordeaux, Bordeaux, France., Oudot C; Pediatric Hematology-Oncology Unit, CHU Limoges, Limoges, France., Rouger-Gaudichon J; Pediatric Hematology-Oncology Unit, CHU Caen, Caen, France., Cheikh N; Pediatric Hematology-Oncology Unit, CHU Besançon, Besançon, France., Poiree M; Pediatric Hematology-Oncology Unit, CHU Lenval Nice, Nice, France., Schneider P; Pediatric Hematology-Oncology Unit, CHU Rouen, Rouen, France., Plat G; Pediatric Hematology-Oncology Unit, CHU Toulouse, Toulouse, France., Contet A; Pediatric Hematology-Oncology Unit, CHU Nancy, Nancy, France., Rialland F; Pediatric Hematology-Oncology Unit, CHU Nantes, Nantes, France., Gouache E; Pediatric Hematology-Oncology Unit, AP-HP Trousseau, Paris, France., Brethon B; Pediatric Hematology Unit, AP-HP Robert Debré, Paris, France., Bertrand Y; Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, University Lyon 1, Lyon, France., Domenech C; Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, University Lyon 1, Lyon, France; Apoptosis, Cancer and Development Laboratory, INSERM U1052, CNRS UMR5286, CRCL, Lyon, France.
Jazyk: angličtina
Zdroj: The Journal of pediatrics [J Pediatr] 2021 Sep; Vol. 236, pp. 204-210. Date of Electronic Publication: 2021 May 13.
DOI: 10.1016/j.jpeds.2021.05.016
Abstrakt: Objective: To obtain a national overview of the epidemiology and management of invasive fungal infections (IFIs) in France for severely immunocompromised children who were treated for acute leukemia or had undergone allogeneic hematopoietic stem cell transplantation (a-HSCT).
Study Design: We performed a national multicenter retrospective study to collect epidemiologic data for proven and probable IFIs in children with acute leukemia under first- line or relapse treatment or who had undergone a-HSCT. We also conducted a prospective practice survey to provide a national overview of IFI management in pediatric hematology units.
Results: From January 2014 to December 2017, 144 cases of IFI were diagnosed (5.3%) in 2721 patients, including 61 cases of candidiasis, 60 cases of aspergillosis, and 23 cases of infection with "emergent" fungi, including 10 cases of mucormycosis and 6 cases of fusariosis. The IFI rate was higher in patients with acute myelogenous leukemia (12.9%) (OR, 3.24; 95% CI, 2.15-4.81; P < .0001) compared with the rest of the cohort. Patients undergoing a-HSCT had an IFI rate of only 4.3%. In these patients, the use of primary antifungal prophylaxis (principally fluconazole) was associated with a lower IFI rate (OR, 0.28; 95% CI, 0.14-0.60; P = 4.90 ×10 -4 ) compared with a-HSCT recipients who did not receive antifungal prophylaxis. The main cause of IFI in children receiving prophylaxis was emergent pathogens (41%), such as mucormycosis and fusariosis, which were resistant to the prophylactic agents.
Conclusions: The emerging fungi and new antifungal resistance profiles uncovered in this study should be considered in IFI management in immunocompromised children.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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