儿科血液肿瘤病房侵袭性真菌病流行病学的变化：突破感染的相关性。
Changes in the epidemiology of invasive fungal disease in a Pediatric Hematology and Oncology Unit: the relevance of breakthrough infections.
机构信息
Pediatric Infectious Diseases Section. Pediatrics Department. Hospital Materno, Infantil Gregorio Marañón. C/ O', Donnell 48-50, 28009, Madrid, Spain.
Hospital General Universitario Gregorio Marañón (Pediatric Hematology and Oncology Unit. Pediatrics Department), Madrid, Spain.
出版信息
BMC Infect Dis. 2023 May 25;23(1):348. doi: 10.1186/s12879-023-08314-9.
BACKGROUND
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.
METHODS
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.
RESULTS
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).
CONCLUSIONS
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.
背景
侵袭性真菌病（IFD）是化疗或造血干细胞移植（HSCT）后儿童发病率和死亡率的重要原因。本研究的目的是描述儿科血液肿瘤科（PHOU）中 IFD 流行病学的变化，该科室的活动随时间增加而增加。
方法
回顾性修订马德里（西班牙）一家三级医院 PHOU 中诊断为 IFD 的儿童（6 个月至 18 岁）的病历。根据 EORTC 修订标准进行 IFD 定义。描述了患病率、流行病学、诊断和治疗参数。根据三个时间段、感染类型（酵母与霉菌感染）和结果，使用卡方检验、Mann-Whitney 和 Kruskal-Wallis 检验进行比较分析。
结果
在 471 名高危儿童中，27 名儿童发生了 28 例 IFD（50%为男性；中位年龄为 9.8 岁，[IQR 4.9-15.1]），总患病率为 5.9%。共登记了 5 例菌血症和 23 例支气管肺部霉菌病。6 例（21.4%）、8 例（28.6%）和 14 例（50%）分别符合确诊、可能和疑似 IFD 的标准。71.4%的患者出现突破感染，28.6%需要重症监护，21.4%在治疗期间死亡。随着时间的推移，支气管肺部霉菌感染和突破 IFD 有所增加（p=0.002 和 p=0.012），发生在 IFD 宿主因素（p=0.028）和高危基础疾病（p=0.012）更多的儿童中。PHOU 的住院人数增加了 64%（p<0.001），HSCT 增加了 277%（p=0.008），但死亡率或 IFD/1000 住院人数并未上升（p=0.674）。
结论
在这项研究中，我们发现酵母感染减少，而霉菌感染随时间增加，其中大多数是突破感染。这些变化可能与我们 PHOU 的活动增加以及患者基础病理的复杂性增加有关。幸运的是，这些情况并没有导致 IFD 患病率或死亡率的增加。
Zotero 插件