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.
J Pediatr. 2021 Sep;236:204-210. doi: 10.1016/j.jpeds.2021.05.016. Epub 2021 May 13.
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).
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.
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) 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.
The emerging fungi and new antifungal resistance profiles uncovered in this study should be considered in IFI management in immunocompromised children.
获取法国严重免疫功能低下儿童侵袭性真菌感染（IFI）流行病学和管理的全国性概述，这些儿童正在接受急性白血病治疗或接受异基因造血干细胞移植（a-HSCT）。
我们进行了一项全国性多中心回顾性研究，以收集处于一线或复发治疗中的急性白血病儿童或接受 a-HSCT 的儿童的确诊和可能 IFI 的流行病学数据。我们还进行了一项前瞻性实践调查，以提供儿科血液病学单位 IFI 管理的全国性概述。
从 2014 年 1 月至 2017 年 12 月，在 2721 例患者中诊断出 144 例 IFI（5.3%），包括 61 例念珠菌病、60 例曲霉菌病和 23 例“新兴”真菌感染，包括 10 例毛霉菌病和 6 例镰刀菌病。与其余队列相比，急性髓细胞性白血病（AML）患者的 IFI 发生率更高（12.9%）（OR，3.24；95%CI，2.15-4.81；P<0.0001）。接受 a-HSCT 的患者 IFI 发生率仅为 4.3%。在这些患者中，使用原发性抗真菌预防（主要是氟康唑）与较低的 IFI 发生率相关（OR，0.28；95%CI，0.14-0.60；P=4.90×10）与未接受抗真菌预防的 a-HSCT 受者相比。接受预防治疗的儿童 IFI 的主要原因是新兴病原体（41%），如毛霉菌病和镰刀菌病，这些病原体对抗真菌药物具有耐药性。
本研究发现的新兴真菌和新的抗真菌耐药谱应在免疫功能低下儿童的 IFI 管理中加以考虑。
