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Fungal Disease Trends in Pediatric Patients, 2016-2019

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      Background

      Fungal infections can be life-threatening to vulnerable populations, including cystic fibrosis (CF) and immunocompromised patients. Our primary objective was to describe patient fungal isolate epidemiology at a pediatric medical center to enable analysis of risk factors for acquisition.

      Methods

      We performed a retrospective review of all fungal isolates from patients admitted to our center between 1/1/2016 and 9/30/2019. We included isolates from any body site and excluded Candida, Histoplasma, Blastomyces, and Cryptococcus species. We extracted patient characteristics from electronic medical records. We used descriptive statistics and rate comparison to identify trends among diagnoses and over time.

      Results

      One-hundred and thirteen patients were included, contributing 138 total fungal isolates. Sixty-six percent of the isolates were collected from throat or lung; 24% were from eye/ear/nose/skin/sinus, and 10% from wound/blood/urine. Aspergillus species were most commonly identified (43%), of which 78% were A. fumigatus. The rate of fungal isolates/1000 patient-days in 2016, 2017, 2018, and 2019 was 0.201, 0.151, 0.117, and 0.304, respectively (0.117 vs. 0.304 isolates/1000 patient-days, p < 0.001). Overall, 24% of patients had CF (annual range 11-36%) and 20% were immunocompromised (annual range 8-28%). Both groups had their highest proportion in 2019. Overall, 25/113 (22%) patients were treated with systemic antifungals; 3 (12%) of those patients had CF and 15 (60%) were immunocompromised. Of the 15 immunocompromised patients treated, 6 (40%) were in 2019.

      Conclusions

      Our cohort divided naturally into three groups: CF, immunocompromised, and other diagnosis. This will enable design of meaningful studies to identify and mitigate risk factors in each population. Increased fungal isolate rate in 2019 may be due to increased proportion of CF and immunocompromised patients. These and future data will be used to devise interventions to prevent healthcare-associated fungal infections.
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