6772 Invasive fungal infection risk in a newly commissioned paediatric cancer centre

Objectives To report our experience at our newly commissioned tertiary pediatric hospital. To identify the different fungal pathogens that cause significant morbidity and mortality in a cohort group of children diagnosed with different childhood cancers. To shed more light on the use of antifungal treatment and prophylaxis that is used in immunocompromised paediatric cancer patients. Methods This is a retrospective descriptive study included all haematology/oncology patients aged 0–18 years who were diagnosed with a proven, probable, or possible invasive fungal disease at the King Faisal Specialist Hospital and Research Center, Madinah, Saudi Arabia, a tertiary children's hospital, between 2021 and 2023. We collected clinical data on the incidence, diagnostic procedures, management, and outcome of invasive fungal disease in children treated for haematological and non-haematological malignancies. Results A total of nine children (12. 8%) were diagnosed with invasive fungal disease out of 70 patients treated for childhood cancer at the same time. Of the majority of the patients, eight were diagnosed with hematologic malignancies, and one patient was diagnosed with rhabdomyosarcoma. All hematologic malignancy patients were diagnosed with IFD during the induction and consolidation phase. Eight patients had changes on their body CT, which were suggestive of invas ive fungal infections. One patient had a positive fungal culture from sinus drainage. Five patients required admission to the pediatric intensive care unit (PICU) for further management and support and one patient died from invasive candidemia despite intensive antifungal treatment. Amphotericin B was used invariably in all the patients in addition to other antifungals. In May 2023 we adopted a new strategy for antifungal prophylaxis for all admitted children with prolonged neutropenia with Caspofungin, and no new diagnosis of invasive fungal disease was reported of patients who received induction/consolidation or intense chemotherapy afterward. Conclusion Invasive fungal disease continued to be a significant cause of morbidity in immunocompromised children despite the recognized improvement in the diagnostic and treatment modalities. The true incidence is not well documented, and most studies were cantered-based. 1 This retrospective monocentric study provides information on the current incidence and outcome of IFD in a real-life setting. Although our study has limited numbers, we think it will be helpful to re-evaluate the current antifungal prophylaxis strategies in children receiving intensive chemotherapy treatment. Reference Huppler AR, Fisher BT, Lehrnbecher T, Walsh TJ, Steinbach WJ. Role of molecular biomarkers in the diagnosis of invasive fungal diseases in children. J Pediatric Infect DisSoc 2017 Sep 1;6 (suppl₁): S32-S44. doi: 10. 1093/jpids/pix054. PMID: 28927202; PMCID: PMC5907877.