1531. The Yield of Fungal Surveillance Cultures in Pediatric Hematopoietic Stem Cell Transplant Patients: a Retrospective Analysis and Survey of Current Practice
Session: Poster Abstract Session: Infections and Transplantation
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • 1531_IDWPOSTER_Youngster.pdf (159.8 kB)
  • Background: Invasive fungal infections (IFI) are a significant cause of morbidity and mortality in pediatric hematopoietic stem cell transplantation (HSCT) recipients. Fungal surveillance cultures (FSC) have been proposed as predictors for development of IFI as well as identifiers of the causative organism. Studies examining the clinical value of FSC have shown conflicting results, with most data collected prior to universal initiation of anti-fungal prophylaxis. We aimed to define the epidemiology of fungal colonization and investigate the utility of FSC for predicting IFI in our patient population.

    Methods: FSC performed from 2005-2011 on HSCT patients as well as laboratory and clinical data were reviewed, and incidence of IFI was determined. Descriptive analyses of culture results and possible associations between FSC and IFI were performed. Finally, a web-based survey of national pediatric HSCT providers was undertaken to evaluate current practice and ascertain the relevance of our results. 

    Results: 5,618 FSC from nares, throat and stool in 360 patients were processed. 861 (15.3%) cx were positive: 569 stool (30.3% of stool cultures), 247 throat (13.2% of throat cultures) and 17 nares (0.09% of nares cultures). 232 patients had one or more positive FSC (64.4%). Candida spp. were the most common organisms (724 cultures, 84%) followed by Saccharomyces cerevisiae (74, 8.5%), and Mucoromycotinia (2, 0.02%). 31 (8.6%) patients met our definition for IFI. Of the FSC positive group 17 (7.9%) developed IFI, which was not significantly different than the FSC negative group (14/128, 10.9%, p=0.245). In patients with a positive FSC, 69 (29.9%) had antifungal coverage changed following the culture. Six (8.6%) went on to develop IFI (2/6 concordance with FSC) compared to 11 (6.7%, p=0.59) that had no treatment change (3/11 concordance). 40 providers responded to our survey (70.8%). 40% reported performing routine FSC on a weekly basis. 25% would not change management based on the results of FSC, and the overall rating of the clinical usefulness of FSC was low (median 24, scale 1-100). 

    Conclusion: FSC have limited clinical value in pediatric HSCT patients. If FSC are pursued, stool cultures show the highest yield for identifying fungal colonization but may not predict the causative pathogen in IFI.

    Ilan Youngster, M.D., Infectious Diseases, Boston Children's Hospital, Boston, MA, Tanvi Sharma, MD, Pediatric Infectious Diseases, Boston Children's Hospital, Harvard Medical School, Boston, MA, Christine Duncan, M.D., Dana-Farber Cancer Institute, Boston, MA and Alexander Mcadam, MD, PhD, Children's Hospital Boston, Boston, MA

    Disclosures:

    I. Youngster, None

    T. Sharma, None

    C. Duncan, None

    A. Mcadam, None

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