Paediatric Acute Invasive Fungal Sinusitis Outcomes Over a 13-Year Period.

Objectives: To identify prognostic factors of paediatric acute invasive fungal sinusitis (AIFS) patients.

Design: Weighted cross-sectional analysis over 13-year period (2006-2019).

Setting: Public national hospitalisation database.

Participants: Immunocompromised paediatric (age < 21 years) patients with sinonasal fungal infection who underwent sinonasal surgical treatment.

Main outcome measures: Clinical characteristics (e.g., medical comorbidities, fungal species, age), mortality rate.

Statistical analysis: To compare mortality rates, the Fisher's exact test was used for individual conditions, each fungal species, and hospital treatment setting. The sample's median age (12 years) divided patients into younger and older groups. For two-sided tests, a p value of < 0.05 was considered significant. A Bonferroni correction was applied to evaluate fungal species and mortality, where a p value < 0.0167 was considered significant.

Results: A weighted total of 408 surgically treated AIFS patients were identified (median age 12 years). The most common immunocompromised comorbidities were neoplasms (75.7%) and hematologic disorders (71.2%). The most common fungal species were "other unspecified mycoses" as defined by ICD codes (53.8%) then mucormycoses (35%). The overall mortality rate was 16.1%. The only immunocompromised comorbidity associated with increased mortality was immunodeficiency disorders (25.3%; p = 0.023). Demographics associated with increased mortality were being male (12.3% vs. 3.9%; p = 0.004), but not older age (56.1% vs. 43.9%; p = 0.588). Patients with aspergillosis infections had increased mortality (26.2%; p = 0.003), but not other fungal species.

Conclusion: In the largest national sample of paediatric AIFS patients, the overall mortality rate was 16.1%. Negative prognostic indicators included male sex, immunodeficiency disorder, and aspergillosis infections.