Invasive Fungal Infections in Immunocompromised Children: Novel Insight Following a National Study - Centre Eugène Marquis Access content directly
Journal Articles The Journal of Pediatrics Year : 2021

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

Damien Dupont

Abstract

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.
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Dates and versions

hal-03666730 , version 1 (16-10-2023)

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Attribution - NonCommercial

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Laura Olivier-Gougenheim, Nicolas Rama, Damien Dupont, Paul Saultier, Guy Leverger, et al.. Invasive Fungal Infections in Immunocompromised Children: Novel Insight Following a National Study. The Journal of Pediatrics, 2021, 236, pp.204-210. ⟨10.1016/j.jpeds.2021.05.016⟩. ⟨hal-03666730⟩
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