Invasive fungal infection in children with persistent febrile neutropenia

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Published on: July 1, 2020

Hsin-Pao Lai1, Yee-Chun Chen, Luan-Yin Chang

  • 1Department of Pediatrics, God's Help Hospital, Taipei, Taiwan.

Journal of the Formosan Medical Association = Taiwan Yi Zhi
|April 9, 2005
PubMed
Abstract

Insights

Invasive fungal infections are common in children with persistent febrile neutropenia. Delayed antifungal therapy significantly increases mortality risk in these vulnerable pediatric patients.

Area of Science:

  • Pediatric Infectious Diseases
  • Hematology-Oncology
  • Epidemiology

Background:

  • Persistent febrile neutropenia in children, especially when refractory to antibiotics, poses a significant risk for invasive fungal infections (IFI).
  • Limited epidemiologic data exists for IFI in this specific pediatric population in Taiwan.

Purpose of the Study:

  • To identify the incidence, risk factors, and outcomes of invasive fungal infections (IFI) in children experiencing persistent febrile neutropenia.
  • To analyze the impact of delayed antifungal therapy on mortality in this patient group.

Main Methods:

  • A retrospective study analyzed 82 episodes of persistent febrile neutropenia in children at a major Taiwanese hospital.
  • Infections were classified as proven, probable, or possible IFI based on established criteria.
  • Multivariate analysis identified independent risk factors for IFI and assessed prognostic factors for mortality.

Main Results:

  • Invasive fungal infections (IFI) occurred in 35.4% of persistent febrile neutropenia episodes, with pneumonia being the most frequent type.
  • Independent risk factors for IFI included prolonged neutropenia (>30 days), extended steroid use, allogeneic bone marrow transplantation, and relapsed malignancy.
  • Patients with IFI had a substantially higher in-hospital mortality rate (51.7% vs. 3.8%).

Conclusions:

  • Invasive fungal infections (IFI) are a common and serious complication in children with persistent febrile neutropenia.
  • Delayed antifungal therapy (fever >7 days) emerged as an independent adverse prognostic factor, significantly increasing mortality risk.

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