Role of Management Strategies in Reducing Mortality From Invasive Fungal Disease in Children With Cancer or Receiving Hemopoietic Stem Cell Transplant
| Autor: | Andrea Moscatelli, Gian Michele Magnano, Roberto Bandettini, Michaela Calvillo, Francesca Bagnasco, Elio Castagnola, Piero Buffa, Cristina Moroni, Maura Faraci, Silvia Caruso, Ilaria Caviglia, Riccardo Haupt, Loredana Amoroso, Giuliana Cangemi |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Male
Microbiology (medical) Allergy medicine.medical_specialty Antifungal Agents Adolescent Single Center 03 medical and health sciences 0302 clinical medicine Risk Factors Neoplasms Internal medicine medicine Humans 030212 general & internal medicine Child Intensive care medicine Retrospective Studies 0303 health sciences 030306 microbiology business.industry Hazard ratio Hematopoietic Stem Cell Transplantation Infant Cancer Retrospective cohort study medicine.disease 3. Good health Transplantation Infectious Diseases Mycoses Child Preschool Pediatrics Perinatology and Child Health Etiology Female Stem cell business |
| Zdroj: | Pediatric Infectious Disease Journal. 33:233-237 |
| ISSN: | 0891-3668 |
| DOI: | 10.1097/inf.0000000000000101 |
| Popis: | Background In the last decades, several diagnostic and therapeutic strategies have been implemented for management of invasive fungal diseases (IFD) in patients with cancer or receiving allogeneic hemopoietic stem cell transplant. Few data are available on their impact on mortality in children. Methods All IFD episodes diagnosed at tertiary care center during a 30-year period between 1983 and 2012 were analyzed for 90-day mortality and risk factors. Diagnoses were coded according to international (European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group) criteria. Four treatment eras (1983-1990, 1991-1999, 2000-2005 and 2006-2012) were defined according to availability of diagnostic technologies, new antifungal drugs and use of a diagnostic-driven approach without empiric antifungal therapy. Results A total of 198 IFD were diagnosed in 191 patients; 71.2% were proven/probable infections; 39.9% were caused by yeasts and 31.3% by molds. Within 90 days from IFD diagnosis, 58 (30.4%) patients died for a 28.3% cumulative probability of death. A multivariable analysis showed that the highest risk of death was associated with alternative donor-hemopoietic stem cell transplant [hazard ratio (HR): 3.96] and mold etiology (HR: 1.34). The risk of death significantly decreased across the treatment eras, with almost a 3-fold reduced risk for patients diagnosed during the 2006-2012 period (HR: 0.24). Also if the variable year of diagnosis was considered as continuous, the hazard of death significantly decreased by 5% per year (HR: 0.95). Conclusions New management strategies resulted in a better prognosis of IFD in children with cancer or hemopoietic stem cell transplant. A diagnostic-driven approach was not associated with an increase in mortality. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|