Changes in the epidemiology of invasive fungal disease in a Pediatric Hematology and Oncology Unit: the relevance of breakthrough infections

• Published in: BMC infectious diseases Vol. 23; no. 1; p. 348
• Main Authors: Calle-Miguel, Laura, Garrido-Colino, Carmen, Santiago-García, Begoña, Moreno Santos, Martha Patricia, Gonzalo Pascual, Henar, Ponce Salas, Beatriz, Beléndez Bieler, Cristina, Navarro Gómez, Marisa, Guinea Ortega, Jesús, Rincón-López, Elena María
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 25-05-2023; BioMed Central; BMC
• Subjects: Adolescent; Analysis; Anemia; At risk youth; Brain cancer; Breakthrough Infections; Candidemia; Chemotherapy; Child; Child, Preschool; Children; Comparative analysis; Criteria; Demographic aspects; Diagnosis; Disease prevention; Epidemiology; Ethics; Female; Fungal diseases; Fungal infections; Fungi; Graft versus host disease; Health aspects; Hematology; Hematopoietic stem cells; Humans; Immunocompromised; Immunosuppressive agents; Infectious diseases; Invasive fungal disease; Invasive Fungal Infections - epidemiology; Leukemia; Lymphoma; Male; Medical records; Methods; Mold; Mortality; Mycoses; Neutropenia; Oncology; Patient outcomes; Patients; Pediatrics; Retrospective Studies; Saccharomyces cerevisiae; Stem cell transplantation; Stem cells; Steroids; Tumors; Yeast; Yeasts; Spain; Children; Epidemiology; Immunocompromised; Invasive fungal disease
• DOI: 10.1186/s12879-023-08314-9
• EISSN: 1471-2334

Invasive fungal disease (IFD) is a significant cause of morbimortality in children under chemotherapy or hematopoietic stem cell transplant (HSCT). The purpose of this study is to describe the changes in the IFD epidemiology that occurred in a Pediatric Hematology-Oncology Unit (PHOU) with an increasing activity over time.
Retrospective revision of the medical records of children (from 6 months to 18 years old) diagnosed with IFD in the PHOU of a tertiary hospital in Madrid (Spain), between 2006 and 2019. IFD definitions were performed according to the EORTC revised criteria. Prevalence, epidemiological, diagnostic and therapeutic parameters were described. Comparative analyses were conducted using Chi-square, Mann-Whitney and Kruskal-Wallis tests, according to three time periods, the type of infection (yeast vs mold infections) and the outcome.
Twenty-eight episodes of IFD occurred in 27 out of 471 children at risk (50% males; median age of 9.8 years old, [IQR 4.9-15.1]), resulting in an overall global prevalence of 5.9%. Five episodes of candidemia and 23 bronchopulmonary mold diseases were registered. Six (21.4%), eight (28.6%) and 14 (50%) episodes met criteria for proven, probable and possible IFD, respectively. 71.4% of patients had a breakthrough infection, 28.6% required intensive care and 21.4% died during treatment. Over time, bronchopulmonary mold infections and breakthrough IFD increased (p=0.002 and p=0.012, respectively), occurring in children with more IFD host factors (p=0.028) and high-risk underlying disorders (p=0.012). A 64% increase in the number of admissions in the PHOU (p<0.001) and a 277% increase in the number of HSCT (p=0.008) were not followed by rising rates of mortality or IFD/1000 admissions (p=0.674).
In this study, we found that yeast infections decreased, while mold infections increased over time, being most of them breakthrough infections. These changes are probably related to the rising activity in our PHOU and an increase in the complexity of the baseline pathologies of patients. Fortunately, these facts were not followed by an increase in IFD prevalence or mortality rates.