268: Update on Fungal Infections in Pediatric Bone Marrow Transplant Patients at the Mattel Children's Hospital at UCLA from 1991–2006

Abstract

Objectives: To identify changes in fungal organisms and characteristics of their infections over time in pediatric bone marrow transplant (BMT) patients. Identify differences in fungal species causing infections in different BMT patients. Methods: We performed a retrospective cohort study of all 324 patients on the pediatric hematology and oncology service at UCLA between 1991 and 2006 who underwent bone marrow transplantation. Cultures positive for fungus were identified from both the microbiology lab database as well as medical record review to identify eighty-three unique infections in fifty-four transplant patients. Results: The overall incidence of fungal infections in BMT recipients was 16.7%. The predominant organisms included: Candida species (55%) and Apergillus species (21%), with Candida albicans accounting for 19% of all fungal species. A variety of other fungal species comprised the remainder of infections. The distribution of organisms over time demonstrated a strong trend towards an increase in rare molds in more recent years. The respiratory tract was the main site of infection (41%) with urine (17%) and blood (11%) also noted as significant sites. Upon stratification of the BMT patients who developed fungal infections, the primary diagnoses were ALL (48%) and myeloid malignancy (35%); underlying diagnosis, however, had little impact on the development of a fungal infection in BMT patients. Of all deaths in the studied population, fungal-related mortality of patients analyzed was 44%. Conclusions: Bone marrow transplant patients have a high risk of fungal infections, likely secondary to their severe and prolonged neutropenia. This risk appears to be increasing over time with rarer organisms becoming more prevalent. This emphasizes the need for the development and implementation of improved diagnostic and therapeutic strategies in order to improve survival in this population. Objectives: To identify changes in fungal organisms and characteristics of their infections over time in pediatric bone marrow transplant (BMT) patients. Identify differences in fungal species causing infections in different BMT patients. Methods: We performed a retrospective cohort study of all 324 patients on the pediatric hematology and oncology service at UCLA between 1991 and 2006 who underwent bone marrow transplantation. Cultures positive for fungus were identified from both the microbiology lab database as well as medical record review to identify eighty-three unique infections in fifty-four transplant patients. Results: The overall incidence of fungal infections in BMT recipients was 16.7%. The predominant organisms included: Candida species (55%) and Apergillus species (21%), with Candida albicans accounting for 19% of all fungal species. A variety of other fungal species comprised the remainder of infections. The distribution of organisms over time demonstrated a strong trend towards an increase in rare molds in more recent years. The respiratory tract was the main site of infection (41%) with urine (17%) and blood (11%) also noted as significant sites. Upon stratification of the BMT patients who developed fungal infections, the primary diagnoses were ALL (48%) and myeloid malignancy (35%); underlying diagnosis, however, had little impact on the development of a fungal infection in BMT patients. Of all deaths in the studied population, fungal-related mortality of patients analyzed was 44%. Conclusions: Bone marrow transplant patients have a high risk of fungal infections, likely secondary to their severe and prolonged neutropenia. This risk appears to be increasing over time with rarer organisms becoming more prevalent. This emphasizes the need for the development and implementation of improved diagnostic and therapeutic strategies in order to improve survival in this population.