Original article Invasive fungal infections in paediatric acute myeloid leukaemia D. L. Johnston, 1 V. Lewis, 2 R. Yanofsky, 3 B. Gillmeister, 4 M. C. Ethier, 4 D. Mitchell, 5 S. Cellot, 6 D. Dix, 7 C. Portwine, 8 V. Price, 9 M. Silva, 10 S. Zelcer, 11 B. Michon, 12 L. Bowes, 13 K. Stobart, 14 J. Brossard, 15 J. Beyene 4,16 and L. Sung 4,17 1 Hematology Oncology, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada, 2 Hematology/Oncology/Transplant Program, Alberta Children’s Hospital, Calgary, AB, Canada, 3 Hematology/Oncology, CancerCare Manitoba, Winnipeg, MB, Canada, 4 Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada, 5 Hematology/Oncology, Montreal Children’s Hospital, Montreal, QC, Canada, 6 Hematology/Oncology, Hospital Sainte- Justine, Montreal, QC, Canada, 7 Pediatric Hematology/Oncology, British Columbia Children’s Hospital, Vancouver, BC, Canada, 8 Hematology/Oncology, McMaster Children’s Hospital at Hamilton Health Sciences, Hamilton, ON, Canada, 9 Pediatrics, IWK Health Centre, Halifax, NS, Canada, 10 Hematology/ Oncology, Cancer Centre of Southeastern Ontario at Kingston, Kingston, ON, Canada, 11 Hematology/Oncology, London Health Sciences, London, ON, Canada, 12 Pediatric Hematology/Oncology Centre, Hospitalier Universitaire de Quebec, Quebec City, QC, Canada, 13 Hematology/Oncology, Janeway Child Health Center, St John’s, NL, Canada, 14 Stollery Children’s Hospital, University of Alberta Hospital, Edmonton, AB, Canada, 15 Hematology/Oncology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada, 16 Population Genomics Program, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada and 17 Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada Summary Invasive fungal infections (IFIs) are a major cause of morbidity and mortality in pae- diatric acute myeloid leukaemia (AML). This study describes risk factors for IFI and IFI-related sepsis in this population. We conducted a population-based, retrospective cohort study of children with AML in Canada. IFIs during chemotherapy and prior to haematopoietic stem cell transplantation, relapse, persistent disease or death were identified. Risk factors for proven or probable IFI were examined. Among courses complicated by IFI, risk factors for sepsis were also evaluated. There were 341 chil- dren with AML included of which 41 (12.0%) experienced 46 different episodes of IFI. Candida species accounted for 23 (50.0%) of IFIs and Aspergillus spp. accounted for 14 (30.4%). Days of broad-spectrum antibiotics, days of corticosteroids and neu- tropenia at start of the course were independently associated with IFI. Only days of fever were independently associated with IFI-related sepsis. Invasive fungal infections occurred in 12.0% of paediatric AML patients. Risk factors for IFI and IFI-related sepsis were identified. This knowledge may help to consider targeted strategies. Key words: Fungal infection, paediatric acute myeloid leukaemia, risk factors. Introduction Infections are major causes of morbidity and mortality in paediatric acute myeloid leukaemia (AML) related to the intensity of treatment and its associated pro- longed and profound neutropenia. Invasive fungal infections (IFIs) are important because they are associated with relatively poor outcomes. Previous studies have demonstrated a cumulative incidence of IFIs in paediatric AML patients undergoing therapy of 5–13% and have found IFIs to be an attributable cause of death in 5–18% of patients. 1–6 Published risk factors for the development of IFIs in paediatric AML patients include long-term administration of broad- spectrum antibiotics, relapse therapy, duration of neutropenia, use of corticosteroid medication and intensive chemotherapy. 1–3,5 The limitations of previous AML studies include fail- ure to use standard classification of IFI according to the European Organization for Research and Treat- ment in Cancer/Mycoses Study Group (EORTC/MSG), 7 patient population consisting only of those enrolled on Correspondence: D. Johnston, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada. Tel.: +(613) 737 7600; ext. 2210. Fax: +(613) 738 4828. E-mail: djohnston@cheo.on.ca Submitted for publication 7 December 2012 Revised 23 January 2013 Accepted for publication 30 January 2013 © 2013 Blackwell Verlag GmbH doi:10.1111/myc.12063 mycoses Diagnosis,Therapy and Prophylaxis of Fungal Diseases