To obtain a national overview of the epidemiology and management of invasive fungal infections (IFIs) in France for severe immunocompromised children who were treated for acute leukemia or had undergone an allogeneic hematopoietic stem cell transplantation (a-HSCT).
We performed a national multicenter retrospective study to collect epidemiologic data for proven and probable IFI in children with acute leukemia under first line or relapse treatment or who had undergone an a-HSCT. We also conducted a prospective practice survey to provide a national overview of IFI management in pediatric hematology units.
From January 2014 to December 2017, 144 cases of IFI were diagnosed (5.3%) among 2721 patients: 61 candidiasis, 60 aspergillosis and 23 “emergent” fungi including 10 mucormycosis and 6 fusariosis. Higher IFI rate occurred in patients with acute myeloid leukemia (12.9%), (OR 3.24, 95% CI [2.15-4.81], P < .0001) compared with the entire cohort. Patients undergoing a-HSCT had an IFI rate of only 4.3%. For these patients, the use of primary antifungal prophylaxis, principally fluconazole, was associated with a lower IFI rate (OR 0.28, 95% CI [0.14-0.60], p= 4.90.10), compared with a-HSCT patients without prophylaxis. However, receiving prophylaxis children had IFI mostly due to emergent pathogens (41%), such as mucormycosis and fusariosis, which were resistant to prophylactic agent.
Emerging fungi and new antifungal resistance profiles uncovered in this study should be considered in IFI management in immunocompromised children.

Copyright © 2021. Published by Elsevier Inc.

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