Title:Invasive Fungal Infections in the Paediatric Intensive Care Unit: A Hong
Kong Study
Volume: 20
Issue: 4
Author(s): Mario Wai Tung Li, Kam Lun Hon*, Karen Ka Yan Leung, Wun Fung Hui, David Christopher Lung and Shau Yin Ha
Affiliation:
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong, China
Keywords:
Critical care, invasive fungal infection, stem cell transplantation, haemato-oncologic diseases, PICU, mortality.
Abstract:
Introduction: Invasive fungal infections (IFI) cause significant mortality and morbidity
in the Paediatric Intensive Care Unit (PICU). Early recognition and prompt treatment of invasive
fungal infections are important. This article reviewed the mortality and morbidity of IFIs in the
PICU of Hong Kong Children’s Hospital.
Methods: A retrospective review of all PICU admissions from April 2019 to May 2021 was performed.
The following data were retrieved: age, gender, diagnosis, comorbidity, clinical manifestation,
type of fungus, duration of stay at PICU, absolute neutrophil count, use of immunosuppressive
therapy, presence of central venous catheter and use of total parental nutrition. The primary outcomes
were the incidence and mortality of IFIs among PICU patients. The secondary outcomes
were risk factors for developing IFI in PICU and clinical course of IFIs. Numerical variables were
compared between groups by Mann-Whitney U test and categorical variables by Fisher’s exact test.
Results: There were 692 PICU admissions over the study period from April 2019 to May 2021. The
crude mortality was 3% (n=24 death cases) in the PICU. Fourteen patients (2%) fulfilling the criteria
for IFIs were identified using hospital electronic record system and according to PICU documentation.
Eight of these 14 patients (57%) had hematological malignancy, 2 (17%) had solid tumours
and 4 had non-oncological conditions. Eight (57%) patients were neutropenic with absolute neutrophil
count less than 1x 109 at diagnosis of IFI. Ten (71%) had received immunosuppressive therapy
including steroid, cyclosporin A, Mycophenolate mofetil (MMF), Sirolimus or tacrolimus. 12 (86%)
had had central venous catheter. Eight (57%) were on parenteral nutrition. IFIs due to Rhizopus or
Aspergillus infection (5/14), or in post-haematopoietic stem cell transplant patients (5/14) were associated
with non-survival (p = 0.031).
Conclusion: All patients with IFIs managed in the PICU had haemato-oncology diseases or were
recipients of stem cell transplantation. IFIs with Rhizopus or Aspergillus as a group were associated
with high mortality in the PICU. Awareness of this pathology with prompt diagnosis and treatment
may improve the outcome of these infections and reduce the mortality.
