Abstract:
BACKGROUND:Invasive mold infections (IMIs) are a leading cause of mortality in immunocompromised children, yet there has never been an international epidemiologic investigation of pediatric IMIs. METHODS:This international, prospective cohort study was performed to characterize the epidemiology, antifungal therapy, and outcomes of pediatric IMIs. Children (≤18 years) with proven or probable IMIs were enrolled between August 2007 and May 2011 at 22 sites. Risk factors, underlying diagnoses, and treatments were recorded. Outcomes were assessed at 12 weeks after diagnosis using European Organization for Research and Treatment of Cancer/Mycoses Study Group response criteria. RESULTS:One hundred thirty-one pediatric patients with IMIs were enrolled; the most common IMI was invasive aspergillosis ([IA] 75%). Children with IA and those with other types of IMIs had similar underlying risk factors, except that children with IMIs caused by non-Aspergillus species were more likely to have received mold-active antifungal agents preceding diagnosis. The most commonly used antifungal classes after diagnosis were triazoles (82%) and polyenes (63%). Combination therapy was used in 53% of patients. Use of combination therapy was associated with an increased risk of adverse events (risk ratio, 1.98; 95% confidence interval, 1.06-3.68; P = .031), although there was no detectable difference in outcome. CONCLUSIONS:Although risk factors for IMIs are similar across specific subtypes, preceding antifungal therapy may be an important modifier. Combination antifungal therapy requires further study to determine its true risks and benefits.
journal_name
J Pediatric Infect Dis Socjournal_title
Journal of the Pediatric Infectious Diseases Societyauthors
Wattier RL,Dvorak CC,Hoffman JA,Brozovich AA,Bin-Hussain I,Groll AH,Castagnola E,Knapp KM,Zaoutis TE,Gustafsson B,Sung L,Berman D,Halasa NB,Abzug MJ,Velegraki A,Sharma TS,Fisher BT,Steinbach WJdoi
10.1093/jpids/piu074subject
Has Abstractpub_date
2015-12-01 00:00:00pages
313-22issue
4eissn
2048-7193issn
2048-7207pii
piu074journal_volume
4pub_type
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