Al Siyabi Bushra, Al-Maqbali Juhaina Salim, Unnikrishnan Meenakshi Dhanalekshmi, Wali Yasir, Al Yazidi Laila
Department of Pharmacy, Sultan Qaboos University Hospital, University Medical City, Muscat 123, Oman.
Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Science, Sultan Qaboos University, Muscat 123, Oman.
J Clin Med. 2024 Nov 26;13(23):7179. doi: 10.3390/jcm13237179.
Invasive fungal infections (IFIs) are a prevalent complication of intensive chemotherapy and hematopoietic stem cell transplantation (HSCT) in the pediatric population and are associated with high morbidity and mortality. We aimed to identify the utilization of antifungal prophylaxis prescriptions and the associated clinical outcomes. A retrospective study included children (≤18 years old) diagnosed with hematological malignancies or undergoing HSCT who are at high risk for developing IFI and received systemic antifungal therapy between January 2018 and April 2024 at Sultan Qaboos University Hospital (SQUH), Oman. A powered sample of 222 patients was included, and 208 (93.69%) received antifungal prophylaxis. Among those who received prophylaxis, 148 (66.67%) received appropriate prophylaxis, 86.06% ( = 179) received appropriate dosage. The patients who did not receive antifungal prophylaxis had higher rates of inpatient IFI requiring treatment (85.71% versus 12.02%, < 0.01), a longer median length of hospital stay (LOS) (67.5 days versus 10 days, = 0.015), and more incidence of 90-day all-cause mortality (21.43% versus 2.88%, < 0.01) than those who received antifungal prophylaxis. Survival analysis demonstrated that these patients had a 12% higher risk for earlier death. Also, being on antifungal prophylaxis reduces the odds of inpatient IFI requiring treatment, with an adjusted odds ratio (aOR) of 0.13 [95% CI: 0.019-0.801]. Antifungal prophylaxis utilization was high, and it markedly decreases the occurrence and enhances the prognosis of IFI. Nonetheless, inconsistencies in practice and a lack of pediatric-specific data underscore the necessity for uniform guidelines and additional research to strengthen preventative methods in this population, and proper TDM utilization could provide more robust insights.
侵袭性真菌感染（IFIs）是儿科人群强化化疗和造血干细胞移植（HSCT）常见的并发症，与高发病率和死亡率相关。我们旨在确定抗真菌预防处方的使用情况及其相关临床结局。一项回顾性研究纳入了2018年1月至2024年4月在阿曼苏丹卡布斯大学医院（SQUH）被诊断为血液系统恶性肿瘤或接受HSCT且有发生IFI高风险并接受全身抗真菌治疗的18岁及以下儿童。纳入了222例有代表性的患者样本，其中208例（93.69%）接受了抗真菌预防。在接受预防的患者中，148例（66.67%）接受了适当的预防，86.06%（n = 179）接受了适当的剂量。未接受抗真菌预防的患者因IFI需要治疗的住院率更高（85.71%对12.02%，P < 0.01），中位住院时间（LOS）更长（67.5天对10天，P = 0.015），90天全因死亡率发生率更高（21.43%对2.88%，P < 0.01），高于接受抗真菌预防的患者。生存分析表明，这些患者早期死亡风险高12%。此外，接受抗真菌预防可降低因IFI需要治疗的住院几率，调整后的优势比（aOR）为0.13 [95%置信区间：0.019 - 0.801]。抗真菌预防的使用率很高，它显著降低了IFI的发生率并改善了其预后。尽管如此，实践中的不一致以及缺乏儿科特异性数据凸显了制定统一指南和开展更多研究以加强该人群预防方法的必要性，而适当使用治疗药物监测（TDM）可提供更有力的见解。
