A Prospective, international cohort study of invasive mold infections in children

Rachel L. Wattier, Christopher C. Dvorak, Jill A. Hoffman, Ava A. Brozovich, Ibrahim Bin-Hussain, Andreas H. Groll, Elio Castagnola, Katherine M. Knapp, Theoklis E. Zaoutis, Britt Gustafsson, Lillian Sung, David Berman, Natasha B. Halasa, Mark J. Abzug, Aristea Velegraki, Tanvi S. Sharma, Brian T. Fisher, William J. Steinbach

Research output: Contribution to journalArticlepeer-review

44 Scopus citations


Background. Invasive mold infections (IMIs) are a leading cause of mortality in immunocompromised children, yet there has never been an international epidemiologic investigation of pediatric IMIs. Methods. This international, prospective cohort study was performed to characterize the epidemiology, antifungal therapy, and outcomes of pediatric IMIs. Children (<18 years) with proven or probable IMIs were enrolled between August 2007 and May 2011 at 22 sites. Risk factors, underlying diagnoses, and treatments were recorded. Outcomes were assessed at 12 weeks after diagnosis using European Organization for Research and Treatment of Cancer/Mycoses Study Group response criteria. Results. One hundred thirty-one pediatric patients with IMIs were enrolled; the most common IMI was invasive aspergillosis ([IA] 75%). Children with IA and those with other types of IMIs had similar underlying risk factors, except that children with IMIs caused by non-Aspergillus species were more likely to have received mold-active antifungal agents preceding diagnosis. The most commonly used antifungal classes after diagnosis were triazoles (82%) and polyenes (63%). Combination therapy was used in 53% of patients. Use of combination therapy was associated with an increased risk of adverse events (risk ratio, 1.98; 95% confidence interval, 1.06-3.68; P = .031), although there was no detectable difference in outcome. Conclusions. Although risk factors for IMIs are similar across specific subtypes, preceding antifungal therapy may be an important modifier. Combination antifungal therapy requires further study to determine its true risks and benefits.

Original languageEnglish (US)
Pages (from-to)313-322
Number of pages10
JournalJournal of the Pediatric Infectious Diseases Society
Issue number4
StatePublished - Dec 2015
Externally publishedYes


  • Antifungal
  • Aspergillosis
  • Mucormycosis
  • Outcome
  • Treatment

ASJC Scopus subject areas

  • General Medicine


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