Journal Article Ppublish
PubMed: 40515497 DOI: 10.1111/myc.70074
Approaches to Invasive Fungal Diseases in Paediatric Cancer Centres: An Analysis of Current Practices and Challenges in Germany, Austria and Switzerland.
Mycoses 68(6):e70074
Authors: Danila Seidel, Zoi Dorothea Pana, Daniel Ebrahimi-Fakhari, Sarina K Butzer, Katrin Mehler, Ilana Reinhold, Arne Simon, Christian Dohna-Schwake, Ines Mack, Nicole Bodmer, Tim Niehues, Alexander Claviez, Alfred Längler, Alfred Leipold, Aram Prokop, Bastian Brummel, Beate Winkler, Bernd Gruhn, Carl Friedrich Classen, Carsten Friedrich, Christa Koenig, Christian Flotho, Fiona Poyer, Freimut Schilling, Gabriele Calaminus, Geeke Sieben, Georg C Schwabe, Harald Reinhard, Heiko-Manuel Teltschik, Heinz Hengartner, Jana Stursberg, Jeanette Greiner, Johann Greil, Jörg Leyh, Jörn-Sven Kühl, Karoline Ehlert, Konrad Bochennek, Marius Rohde, Martin Demmert, Martina Stiefel, Matthias Eyrich, Meinolf Siepermann, Michael Frühwald, Michaela Döring, Michaela Nathrath, Milen Minkov, Monika Streiter, Neil Jones, Nora Naumann-Bartsch, Norbert Jorch … and 19 other authors
Affiliations
- Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
- Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
- Medical School, University of Nicosia (UNIC), Nicosia, Cyprus.
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and Dept. of Pediatric Hematology/Oncology, University Children's Hospital Münster, Münster, Germany.
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
- Department of Pediatric Hematology and Oncology, University Medical Center of Saarland, Homburg/Saar, Germany.
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Infectiology, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
- Department of Paediatric Infectious Diseases and Vaccinology, University Children's Hospital Basel (UKBB) and University of Basel, Basel, Switzerland.
- Department of Oncology, University Children's Hospital Zurich, Zurich, Switzerland.
- Centre for Child and Adolescent Health, Helios Klinikum Krefeld, Germany.
- Department of Pediatrics, University Hospital Magdeburg, Magdeburg, Germany.
- Clinic for Pediatric Oncology and Hematology, Hannover Medical School, Hannover, Germany.
- Department of Paediatrics and Adolescent Medicine, Community Hospital Herdecke, Herdecke, Germany.
- Children's Hospital Karlsruhe, Karlsruhe, Germany.
- Campus University Medical School Hamburg (MSH), Helios Clinic Schwerin, Schwerin, Germany.
- Department of Pediatric Oncology and Hematology, Klinikum Dortmund, Dortmund, Germany.
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- Department of Pediatrics, Jena University Hospital, Jena, Germany.
- Section of Pediatric Oncology and Palliative Medicine, Klinik für Kinder- und Jugendmedizin, Universitätsmedizin Rostock, Rostock, Germany.
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Carl von Ossietzky Universität Oldenburg, Klinikum Oldenburg AöR, Oldenburg, Germany.
- Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany.
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria.
- Pediatric Oncology-Hematology, Children's Hospital of Central Switzerland, Lucerne, Switzerland.
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany.
- Pediatric Oncology and Hematology, University Medical Center Mannheim, Mannheim, Germany.
- Children's Hospital, Medical University Lausitz-Carl Thiem, Cottbus, Germany.
- Department of Pediatrics, Asklepios Children's Hospital, Sankt Augustin, Germany.
- Department of Hematology and Oncology, Children's Hospital Stuttgart-Olgahospital, Stuttgart, Germany.
- Pediatric Hospital of Eastern Switzerland St Gallen, St Gallen, Switzerland.
- Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm, Germany.
- Pediatric Oncology-Hematology, Children's Hopital, Cantonal Hospital Aarau, Aarau, Switzerland.
- Department of Pediatric Hematology, Oncology and Immunology, University Hospital Heidelberg, Heidelberg, Germany.
- Department of Pediatric Hematology and Oncology, Klinik Hallerwiese-Cnopfsche Kinderklinik, Nürnberg, Germany.
- Department of Pediatric Oncology, Hematology and Hemostaseology, University of Leipzig, Leipzig, Germany.
- Department of Pediatric Hematology and Oncology, University Medicine Greifswald, Greifswald, Germany.
- Department of Pediatrics, Division of Hematology, Oncology and Hemostaseology, Goethe University Frankfurt, Frankfurt/Main, Germany, Frankfurt am Main, Germany.
- Pediatric Hematology and Oncology, University Hospital Giessen, Giessen, Germany.
- Clinic for Pediatric and Adolescent Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany.
- Department of Pediatrics, Martin-Luther-University Halle-Wittenberg, Halle, Germany.
- Department of Pediatric Haematology, Oncology and Stem Cell Transplantation, University Medical Center, University Children's Hospital, University of Würzburg, Würzburg, Germany.
- Clinic for Children and Youth Medicine, Department for Pediatric Hematology/Oncology, Children's Hospital Amsterdamer Straße, Cologne, Germany.
- Swabian Children's Cancer Center, Pediatrics and Adolescent Medicine, University Medical Center Augsburg, Augsburg, Germany.
- Department of Paediatric Haematology/Oncology, Children's University Hospital, Tübingen, Germany.
- Department of Pediatrics and Children's Cancer Research Center, School of Medicine, Technical University of Munich, Munich, Germany.
- Pediatric Hematology and Oncology, Klinikum Kassel, Kassel, Germany.
- Division of Pediatric Oncology, Department of Pediatrics and Adolescent Medicine, Johannes Kepler University, Linz, Austria.
- Clinic for Pediatrics and Adolescent Medicine, Hematology/Oncology, Klinikum am Gesundbrunnen Heilbronn, Heilbronn, Germany.
- Department of Pediatrics and Adolescent Medicine University Clinics, Salzburg, Austria.
- Department for Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany.
- University Children's Hospital, Evangelisches Klinikum Bethel, Bielefeld, Germany.
Abstract
BACKGROUND
Invasive fungal diseases (IFD) pose significant challenges in paediatric oncology. Their management is complicated by limited paediatric-specific evidence, lack of standardised protocols and variability in resources across centres. This study assessed current practices and addressed the challenges in the prevention, diagnosis and treatment of IFDs in paediatric oncology centres across Germany, Austria and Switzerland.
METHODS
A questionnaire was distributed to senior paediatric oncologists in 70 paediatric oncology centres across Germany, Austria and Switzerland, gathering data on centre infrastructure, infectious disease (ID) expertise, annual cumulative IFD incidence in 2023, diagnostic tools, antifungal prophylaxis, treatment and follow-up practices for IFD. Responses were analysed descriptively.
RESULTS
Sixty-two centres responded, with a median of 56 (IQR 40-75) new oncological diagnoses per centre; 54.8% of centres managed allogeneic HCT patients. IFDs were reported in 88.7% of centres, with a median cumulative IFD incidence of 4.6% (IQR 3.0%-5.9%). No significant association was found between cumulative IFD incidence and the number of transplants, antifungal prophylaxis protocols and availability of ID consultation services. ID consultation was available in 58.1% of centres, with 24/7 support provided in 41.7% of these centres. Larger centres more frequently had paediatric ID specialists, ID consultation services and access to therapeutic drug monitoring.
CONCLUSIONS
The observed heterogeneity in mycology expertise and IFD management strategies across centres reflects the inherent complexity of IFDs and the diagnostic and therapeutic uncertainties amid limited evidence. Strengthening oncology-ID networks and implementing digital consultation platforms may promote high-quality, equitable care, particularly for those with fewer in-house resources.
MeSH
Incidence, Neoplasms, Mycoses, Diagnosis, Therapeutics, Aspergillosis, Child