Cambios en la epidemiología de las infecciones fúngicas e impacto de la profilaxis primaria con voriconazol en una cohorte pediátrica de receptores de trasplante de células progenitoras hematopoyéticas

Invasive fungal infections (IFI) are an important cause of morbidity and mortality after hematopoietic stem cell transplantation (HSCT). At the end of 2013, due to an increase in IFI by FF, our hospital decided to change antifungal primary prophylaxis with fluconazole for voriconazole during neutropenia up to 100 days after HSCT. Objective: to analyse effects of the change of antifungal primary prophylaxis in a retrospective cohort of recipients of HSCT. Materials and methods: we performed a retrospective analysis of all patients, who underwent HSCT at Hospital Garrahan between 2012-2013 (P1) and 2014- 2015 (P2); we analyzed patients that showed IFI. Results: frequency of IFI, transplant related mortality (TRM), and direct mortality due to IFI (DMIFI) in recipients of HSCT with antifungal primary prophylaxis. IFI: P1, 21/55 (38,1%) vs. P2 6/47 (12,7%) p 0,047. IFI due to yeasts: P1 9/55 (16,3%) vs. P2 3/47 (6,3%). IFI due to FF: P1 12/55 (21,8%) vs. P2 3/47 (6,3%) p 0,047. TRM: P1 21/55 (38,1%) vs. P2 7/47 (14,8%) p <0,01. DMIFI: P1 5/55 (9%) vs. P2 0/47 (0%) Conclusion: primary prophylaxis with voriconazole was associated with a decrease in IFI due to HF FF and DMIFI. There was also a decrease in TRM between both periods. The risk of mucormycosis emergency requires strict epidemiological follow-up.