Abstract / Summary
Abstract Background Invasive fungal disease (IFD) is a major cause of mortality and morbidity in immunocompromised children, particularly those with hematological malignancies or undergoing hematopoietic cell transplantation (HCT). Aim To analyze the incidence of fungal infections and identify the risk factors for infection-related mortality. Methods Clinical and microbiological data were retrospectively evaluated for children treated across 17 pediatric hematology and oncology centers (PHO) and 6 pediatric HCT centers in Poland. Results Over the 6-year study period, 846 fungal infections were recorded in 5,564 PHO patients and 158 in 1,064 HCT recipients, with a similar (13.2% vs.14.5%, p = 0.179). Acute leukemia was the strongest independent predictor of fungal infection ( OR 3.14, 95% CI: 2.75–3.71; p < 0.001), while age > 8 years, disease relapse and allogeneic transplantation were additional risk factors. Infection-related mortality was significantly higher in HCT recipients than in PHO patients (21.3% vs. 6.7%; OR 3.96, 95% CI 2.36–6.65; p < 0.001). Most deaths occurred within 30 days of diagnosis, predominantly due to Aspergillus spp. and Candida spp., despite antifungal prophylaxis. Conclusions Although IFD incidence was comparable, HCT recipients had nearly fourfold higher infection-related mortality. This highlights the need of improved supportive care and antifungal prophylaxis.