Abstract：
BACKGROUND: Invasive fungal diseases (IFD) are high morbidity and mortality infections in children with cancer suffering episodes of high-risk febrile neutropenia (HRFN). IFD epidemiology has changed in the last two decades, with an increasing incidence in recent years due to the growing number of immunocompromised children at risk for IFD. The aim of this study was to evaluate the incidence of IFD in children with cancer in the period 2016-2020 compared to 2004-2006 in six hospitals in Chile.
METHODS: Prospective, multicentre study, carried out between 2016 and 2020 in six hospitals in Chile. The defined cohort corresponds to a dynamic group of HRFN episodes in patients <18 years old with cancer, who at the fourth day of evolution still presented fever and neutropenia (persistent HRFN). Each episode was followed until resolution of FN. The incidence of IFD was calculated between 2016 and 2020 and compared with data obtained in the period 2004-2006. The incidence rate was estimated.
RESULTS: A total of 777 episodes of HRFN were analysed; 257 (33.1%) were considered as persistent-HRFN occurring in 174 patients. The median age was 7 years (IQR: 3-12 years) and 52.3% (N = 91) were male. Fifty-three episodes of IFD were detected: 21 proven, 14 probable and 18 possible. Possible IFD were excluded, leaving 239 episodes of persistent-HRFN with an IFD incidence of 14.6% (95% CI 10.5-19.9) and an incidence rate of 13.6 IFD cases per 1000 days of neutropenia (95% CI 9.5-20.0). Compared to 2004-2006 cohort (incidence: 8.5% (95% CI 5.2-13.5)), a significant increase in incidence of 6.1% (95% CI 0.2-12.1, p = .047) was detected in cohorts between 2016 and 2020.
CONCLUSIONS: We observed a significant increase in IFD in 2016-2020, compared to 2004-2006 period.
METHODS: Prospective, multicentre study, carried out between 2016 and 2020 in six hospitals in Chile. The defined cohort corresponds to a dynamic group of HRFN episodes in patients <18 years old with cancer, who at the fourth day of evolution still presented fever and neutropenia (persistent HRFN). Each episode was followed until resolution of FN. The incidence of IFD was calculated between 2016 and 2020 and compared with data obtained in the period 2004-2006. The incidence rate was estimated.
RESULTS: A total of 777 episodes of HRFN were analysed; 257 (33.1%) were considered as persistent-HRFN occurring in 174 patients. The median age was 7 years (IQR: 3-12 years) and 52.3% (N = 91) were male. Fifty-three episodes of IFD were detected: 21 proven, 14 probable and 18 possible. Possible IFD were excluded, leaving 239 episodes of persistent-HRFN with an IFD incidence of 14.6% (95% CI 10.5-19.9) and an incidence rate of 13.6 IFD cases per 1000 days of neutropenia (95% CI 9.5-20.0). Compared to 2004-2006 cohort (incidence: 8.5% (95% CI 5.2-13.5)), a significant increase in incidence of 6.1% (95% CI 0.2-12.1, p = .047) was detected in cohorts between 2016 and 2020.
CONCLUSIONS: We observed a significant increase in IFD in 2016-2020, compared to 2004-2006 period.
摘要：
背景：侵袭性真菌病（IFD）是患有高风险发热性中性粒细胞减少症（HRFN）的癌症儿童的高发病率和高死亡率感染。IFD流行病学在过去的二十年里发生了变化，近年来，由于面临IFD风险的免疫功能低下儿童的数量不断增加，发病率不断增加。这项研究的目的是评估智利六家医院与2004-2006年相比，2016-2020年期间儿童癌症IFD的发病率。
方法：前瞻性，多中心研究，2016年至2020年在智利的六家医院进行。定义的队列对应于<18岁的癌症患者的HRFN发作的动态组，在进化的第四天仍然出现发烧和中性粒细胞减少症（持续性HRFN）。每集都在FN解决之前。IFD的发病率是在2016年至2020年之间计算的，并与2004年至2006年期间获得的数据进行比较。估计发病率。
结果：共分析了777例HRFN；174例患者中257例（33.1％）被认为是持续性HRFN。中位年龄为7岁（IQR：3-12岁），男性占52.3％（N=91）。检测到53例IFD：21例证实，14个可能，18个可能。可能的IFD被排除,留下239次持续性HRFN发作，IFD发生率为14.6％（95％CI10.5-19.9），每1000天中性粒细胞减少症发生率为13.6例IFD（95％CI9.5-20.0）。与2004-2006年队列相比（发病率：8.5%（95%CI5.2-13.5）），2016~2020年,队列中的发病率显著增加6.1%(95%CI0.2~12.1,p=.047).
结论：我们观察到，与2004-2006年相比，2016-2020年的IFD显着增加。
方法：前瞻性，多中心研究，2016年至2020年在智利的六家医院进行。定义的队列对应于<18岁的癌症患者的HRFN发作的动态组，在进化的第四天仍然出现发烧和中性粒细胞减少症（持续性HRFN）。每集都在FN解决之前。IFD的发病率是在2016年至2020年之间计算的，并与2004年至2006年期间获得的数据进行比较。估计发病率。
结果：共分析了777例HRFN；174例患者中257例（33.1％）被认为是持续性HRFN。中位年龄为7岁（IQR：3-12岁），男性占52.3％（N=91）。检测到53例IFD：21例证实，14个可能，18个可能。可能的IFD被排除,留下239次持续性HRFN发作，IFD发生率为14.6％（95％CI10.5-19.9），每1000天中性粒细胞减少症发生率为13.6例IFD（95％CI9.5-20.0）。与2004-2006年队列相比（发病率：8.5%（95%CI5.2-13.5）），2016~2020年,队列中的发病率显著增加6.1%(95%CI0.2~12.1,p=.047).
结论：我们观察到，与2004-2006年相比，2016-2020年的IFD显着增加。
