Subject(s)
Antifungal Agents/pharmacology , Yeasts/drug effects , Blood/microbiology , Candida/drug effects , Candida/isolation & purification , Drug Resistance, Microbial , Fluconazole/pharmacology , Humans , Microbial Sensitivity Tests , Mycoses/drug therapy , Mycoses/microbiology , Mycoses/mortality , Neoplasms/complications , Neoplasms/mortality , Yeasts/isolation & purificationABSTRACT
The aim of this prospective study on fungemia in children with cancer compared with adults with cancer appearing during the last 10 years in a pediatric hospital and in national cancer institutions was to investigate risk factors, etiology, therapy, complications and outcome. Univariate analysis showed significant differences in 35 children with cancer and fungemia in comparison with 130 cases of fungemias in adults with cancer. It was found that (1) therapy with corticosteroids (40 vs 18.5%, P<0.03), (2) breakthrough fungemia during ketoconazole prophylaxis (20 vs 7.7%, P<0.025), and (3) meningitis as a complication of fungemia (11.4 vs 0.8%, P< 0.001) occurred more frequently in the pediatric subgroup with fungemia. Candida albicans was more common as the causative agent of fungemia among adults (58.5 vs 37.1, P<0.02) than in children. However, mortality was similar in children with cancer and in adults with cancer and fungemia (31.4 vs 23.1%, NS). Comparison of risk factors revealed no differences between adults and children with cancer and fungemia except in etiology, breakthrough fungemia during prophylaxis with ketoconazole, prior therapy with corticosteroids and meningitis as a complication. The outcome was also similar in pediatric and adult cancer patients with fungal bloodstream infection.
Subject(s)
Antifungal Agents/therapeutic use , Fungemia , Neoplasms/complications , Adolescent , Adrenal Cortex Hormones/therapeutic use , Adult , Candida albicans/isolation & purification , Candida albicans/pathogenicity , Candidiasis/epidemiology , Candidiasis/etiology , Candidiasis/therapy , Child , Child, Preschool , Female , Fungemia/epidemiology , Fungemia/etiology , Fungemia/therapy , Hospitals, Pediatric/statistics & numerical data , Humans , Incidence , Infant , Ketoconazole/therapeutic use , Male , Meningitis/etiology , Meningitis/microbiology , Neoplasms/microbiology , Prospective Studies , Risk Factors , Treatment OutcomeABSTRACT
One hundred and eighteen (118) episodes of bacteremia and fungemia in children with cancer were compared to 401 episodes of bacteremia and fungemia in adults with cancer to assess differences in etiology, risk factors and outcome. A retrospective univariate analysis was performed of all episodes of bacteremia in national pediatric and adult cancer institutions appearing in 1990-1996. A total of 519 episodes of bacteremia were assessed and compared. Both cancer centers differed in prophylactic antibiotic policies. About 50% of adults but less than 5% of children received quinolone prophylaxis during neutropenia, even though the empiric antibiotic therapeutic strategy was similar. There were differences in etiology between the groups: staphylococci and Stenotrophomonas maltophilia were more frequently observed in children (P<0.01), Pseudomonas aeruginosa and Acinetobacter spp. in adults (P<0.05). Gram-positive bacteremia was surprisingly more commonly observed in adults (65.7% vs 33.3%, P<0.01). Mixed polymicrobial bacteremia occurred more commonly in adults (31.8% vs 7.6%, P<0.001) than in children. Analysis of risk factors did not observe differences in risk factors except for underlying disease (acute leukemia was more frequently observed in children -48.3% vs adults 33.7%, P<0.05 and prophylaxis: (prior prophylaxis with quinolones was more common in adults (47.5%) than in children (2.5%) P<0.0001). Overall and attributable mortality in pediatric bacteremia was significantly lower than in adults (P<0.03).
