Antifungal combination therapy for invasive fungal infections in a paediatric oncology and haematology department: A retrospective analysis of practice.
J Mycol Med
; 32(3): 101276, 2022 Aug.
Article
en En
| MEDLINE
| ID: mdl-35405593
ABSTRACT
BACKGROUND:
Invasive fungal infections (IFI) are an important cause of morbidity and mortality in children with leukaemia. International guidelines recommend a monotherapy for most IFI. The use of antifungal combination therapy (ACT) has been reported, but clinical data supporting these combinations are scarce, particularly in paediatrics.OBJECTIVE:
To describe, among patients treated in our department, the situations in which an ACT was used.RESULTS:
Between January 2017 and December 2020, 239 patients (406 hospital stays) benefited from systemic antifungals. Among them, ACT was prescribed for 14 (5.9%) patients (13 leukaemia, 1 aplastic anaemia) corresponding to 16 (3.9%) hospital stays. IFI cases treated with ACT were mainly proven (n=9) or probable (n=4). Seven cases required admission to the intensive care unit. The most commonly used antifungal agents were liposomal amphotericin B (n=13), caspofungin (n=12) and voriconazole (n=9). In 13 cases, monotherapy was prescribed as first-line therapy and changed to an ACT for an uncontrolled infection. But in 3 cases, the ACT was started immediately. The response at 12 weeks after diagnosis of proven/probable IFI was successful in 12 cases (92.3%). The only IFI-related death was attributed to disseminated mucormycosis. ACT were generally well tolerated. In 4 cases, adverse events led to the discontinuation of the offending antifungal agent.CONCLUSION:
This retrospective analysis of practices shows that the use of ACT in our paediatric haemato-oncology department is rare, and concerns the most severe cases and/or those not responding to the first line treatment. In most cases, ACT was efficient and well tolerated.Palabras clave
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Leucemia
/
Infecciones Fúngicas Invasoras
/
Hematología
Tipo de estudio:
Guideline
/
Observational_studies
Límite:
Child
/
Humans
Idioma:
En
Revista:
J Mycol Med
Año:
2022
Tipo del documento:
Article
País de afiliación:
Francia