A prospective, multicentre survey on antifungal therapy in neutropenic paediatric haematology patients.
Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy Istituto di Ematologia, Università Cattolica S. Cuore, Roma, Italy Pediatric Hematology Oncology, Ospedale Infantile Regina Margherita, Torino, Italy Department of Pediatric Hematology and Oncology, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Italy Pediatric Hematology Oncology, A.R.N.A.S. Ospedalie Civico Di Cristina e Benfratelli, Palermo, Italy Clinica Pediatrica dell’Università di Milano Bicocca, Ospedale S. Gerardo, Monza, Italy Pediatric Oncology and Hematology Lalla Seràgnoli Unit, University of Bologna, Bologna, Italy Clinic of Infectious Diseases, University of Bologna, Bologna, Italy Division of Hematology, Spedali Civili, Brescia, Italy Division of Hematology, Ospedale Niguarda Ca’ Granda, Milano, Italy Pediatric Hematology Oncology, University of Perugia, Perugia, Italy.
Invasive fungal infections are a frequent complication after intensive chemotherapy. The aims of this prospective study were to describe the use of antifungal therapy and to report which strategy was routinely adopted to guide the introduction of antifungal therapy. A total of 321 febrile episodes in 160 paediatric patients affected by acute leukaemia or non-Hodgkin-lymphoma were investigated. Antifungal therapy was used in 100 of 321 febrile episodes (31%), and classified as empiric in 73 episodes, diagnostic-driven in 25 episodes and targeted in 2 episodes. Switching to a second-line antifungal therapy was needed in 28 of 100 episodes (28%) and was classified as empiric in 10 episodes (36%), diagnostic-driven in 17 episodes (61%) and targeted in 1 episode (4%). In 9 of 28 episodes (32%), switching to a third-line antifungal therapy was performed and was classified as empiric in 2 episodes (22%), diagnostic-driven in 6 episodes (67%) and targeted in 1 episode (11%). Invasive fungal infections was reported in 23 of 100 episodes: confirmed in 4 episodes, probable in 8 episodes, and possible in 11 episodes. Attributable mortality was 2.8%. Antifungal therapy was still used mostly empirically, whereas as fever persisted, its modification was guided by a diagnostic-driven approach.
© 2012 Blackwell Verlag GmbH.
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