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Bacterial and fungal infection risk in AYA and pediatric patients with ALL
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A retrospective, case-control study compared the risk of invasive fungal infections (IFI) and bacterial blood-stream infections (BSI) in adolescent and young adult (AYA; aged 15–25 years) and pediatric (aged 1–14 years) patients with acute lymphoblastic leukemia (ALL).1 This study included 83 and 230 AYA and pediatric patients, respectively, from four French centers (2 pediatric and 2 adult). Results from this study were published in The Pediatric Infectious Disease Journal by Trimbour et al.1 |
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AYA patients experienced a higher risk of IFI compared with pediatric patients, with an IFI occurrence rate of 22% vs 10% (p = 0.0007). The type of IFI also differed between the two groups (p = 0.0009) with candidiasis more common in AYA patients (47% vs 30.5%) and aspergillosis more frequent in pediatric patients (32% vs 48%). |
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The rates of BSI were comparable between AYA and pediatric patients (51% vs 48%; p = 0.66). However, the occurrence of BSI (p = 0.021) and IFI (p = 0.029) increased in the high- and medium-risk groups in AYA patients compared with pediatric patients. |
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Multivariable analysis demonstrated that AYA (p = 0.047) and high-risk disease (p = 0.018) were risk factors for developing IFI, while only risk group stratification was associated with the risk of developing BSI (p = 0.033), emphasizing the importance of infection monitoring and prevention strategies tailored to the patient’s risk level. |
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Despite the higher incidence of IFI in AYAs, these were not associated with increased mortality compared with pediatric patients (p = 0.55), indicating that while IFI were more frequent, they were not more severe.
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The results suggest that AYAs have increased risk of fungal infection compared with pediatric patients and large prospective studies are warranted to further elucidate the differences in infection rates between AYA and pediatric patients with ALL.
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- Trimbour C, Balsat M, Olivier L, et al. New insights into infections' risk of adolescents and young adults treated for acute lymphoblastic leukemia. Pediatr Infect Dis J. Online ahead of print. DOI: 10.1097/INF.0000000000004493
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