Approaches to Invasive Fungal Diseases in Paediatric Cancer Centres: An Analysis of Current Practices and Challenges in Germany, Austria and Switzerland.
Danila Seidel, Zoi Dorothea Pana, Daniel Ebrahimi-Fakhari, Sarina K Butzer, Katrin Mehler, Ilana Reinhold, Arne Simon, Christian Dohna-Schwake, Ines Mack, Nicole Bodmer, Tim Niehues, Alexander Claviez, Alfred Längler, Alfred Leipold, Aram Prokop, Bastian Brummel, Beate Winkler, Bernd Gruhn, Carl Friedrich Classen, Carsten Friedrich, Christa Koenig, Christian Flotho, Fiona Poyer, Freimut Schilling, Gabriele Calaminus, Geeke Sieben, Georg C Schwabe, Harald Reinhard, Heiko-Manuel Teltschik, Heinz Hengartner, Jana Stursberg, Jeanette Greiner, Johann Greil, Jörg Leyh, Jörn-Sven Kühl, Karoline Ehlert, Konrad Bochennek, Marius Rohde, Martin Demmert, Martina Stiefel, Matthias Eyrich, Meinolf Siepermann, Michael Frühwald, Michaela Döring, Michaela Nathrath, Milen Minkov, Monika Streiter, Neil Jones, Nora Naumann-Bartsch, Norbert Jorch, Olaf Beck, Rita Beier, Roman Crazzolara, Silke Kietz, Simon Vieth, Stefan Fröhling, Stephan Lobitz, Sujal Ghosh, Tanja C Vallée, Thilo Müller, Thomas Wiesel, Tobias Däbritz, Udo Kontny, Uwe Thiel, Volker Strenger, Wolfgang R Eberl, Oliver A Cornely, Andreas H Groll, Thomas Lehrnbecher
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引用次数: 0
Abstract
Background: Invasive fungal diseases (IFD) pose significant challenges in paediatric oncology. Their management is complicated by limited paediatric-specific evidence, lack of standardised protocols and variability in resources across centres. This study assessed current practices and addressed the challenges in the prevention, diagnosis and treatment of IFDs in paediatric oncology centres across Germany, Austria and Switzerland.
Methods: A questionnaire was distributed to senior paediatric oncologists in 70 paediatric oncology centres across Germany, Austria and Switzerland, gathering data on centre infrastructure, infectious disease (ID) expertise, annual cumulative IFD incidence in 2023, diagnostic tools, antifungal prophylaxis, treatment and follow-up practices for IFD. Responses were analysed descriptively.
Results: Sixty-two centres responded, with a median of 56 (IQR 40-75) new oncological diagnoses per centre; 54.8% of centres managed allogeneic HCT patients. IFDs were reported in 88.7% of centres, with a median cumulative IFD incidence of 4.6% (IQR 3.0%-5.9%). No significant association was found between cumulative IFD incidence and the number of transplants, antifungal prophylaxis protocols and availability of ID consultation services. ID consultation was available in 58.1% of centres, with 24/7 support provided in 41.7% of these centres. Larger centres more frequently had paediatric ID specialists, ID consultation services and access to therapeutic drug monitoring.
Conclusions: The observed heterogeneity in mycology expertise and IFD management strategies across centres reflects the inherent complexity of IFDs and the diagnostic and therapeutic uncertainties amid limited evidence. Strengthening oncology-ID networks and implementing digital consultation platforms may promote high-quality, equitable care, particularly for those with fewer in-house resources.
期刊介绍：
The journal Mycoses provides an international forum for original papers in English on the pathogenesis, diagnosis, therapy, prophylaxis, and epidemiology of fungal infectious diseases in humans as well as on the biology of pathogenic fungi.
Medical mycology as part of medical microbiology is advancing rapidly. Effective therapeutic strategies are already available in chemotherapy and are being further developed. Their application requires reliable laboratory diagnostic techniques, which, in turn, result from mycological basic research. Opportunistic mycoses vary greatly in their clinical and pathological symptoms, because the underlying disease of a patient at risk decisively determines their symptomatology and progress. The journal Mycoses is therefore of interest to scientists in fundamental mycological research, mycological laboratory diagnosticians and clinicians interested in fungal infections.
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