Retrospective study on the incidence and outcome of proven and probable invasive fungal infections in high-risk pediatric onco-hematological patients
Retrospective study on the incidence and outcome of proven and probable invasive fungal infections in high-risk pediatric onco-hematological patients
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DOI：
10.1111/ejh.12910
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发表时间：
2017-09-01
影响因子：
3.1
通讯作者：
Caselli, Desiree
中科院分区：
文献类型：
--
作者：
Cesaro, Simone;Tridello, Gloria;Caselli, Desiree
背景侵袭性真菌感染（IFI）是接受化疗或造血干细胞移植（HSCT）的儿童的发病率、死亡率和医疗费用增加的原因。方法多中心、回顾性研究评估2006年至2012年接受急性白血病、非霍奇金淋巴瘤治疗或接受HSCT的儿童中证实和可能的IFI（PP-IFI）的发生率、结局。123名患者诊断出127例PP-IFI，中位年龄为9.7岁。一线化疗后1年累积发生率为2.5%（CI 1.8-3.7），复发后为9.4%（CI 5.8-15.0），HSCT后为5.3%（CI 3.9-7.1）。98例（77%）患者出现重度中性粒细胞减少。经培养证实的病原体为念珠菌属，大多数为非白色念珠菌，28例，霉菌23例，而通过组织病理学鉴定了3例经证实的IFI。在诊断后3个月内观察到77例（89%）对治疗有良好反应。总体90天生存概率为68%（CI 59-76）。结论：无论感染发生在一线化疗、疾病复发的再诱导化疗或HSCT后，约三分之二的PP-IFI儿科患者存活。需要进一步的前瞻性研究来确定抗真菌预防和早期联合治疗对短期总生存率的影响。
BackgroundInvasive fungal infection (IFI) is a cause of morbidity, mortality and increased health costs in children undergoing chemotherapy or hematopoietic stem cell transplant (HSCT).MethodsMulticenter, retrospective study to assess the incidence, outcome of proven and probable IFI (PP-IFI) in children treated for acute leukemia, non-Hodgkin lymphoma or who underwent HSCT from 2006 to 2012.ResultsOver the 7-year period, 127 PP-IFI were diagnosed in 123 patients, median age of 9.7years. The 1-year cumulative incidence was 2.5% (CI 1.8-3.7) after frontline chemotherapy, 9.4% (CI 5.8-15.0) after relapse, and 5.3% (CI 3.9-7.1) after HSCT. Severe neutropenia was present in 98 (77%) patients. Culture-proven agents were Candida spp., mostly non-albicans, 28, mold 23, whereas three proven IFI were identified by histopathology. Favorable response to treatment within 3months from diagnosis was observed in 77 (89%). The overall ninety-day probability of survival was 68% (CI 59-76).ConclusionsAbout two-thirds of pediatric patients with PP-IFI survived, regardless of whether the infection occurred after frontline chemotherapy, reinduction chemotherapy for disease relapse, or after HSCT. Further prospective studies are needed to define the impact of antifungal prophylaxis and early combination therapy on short-term overall survival.