Published online March 13, 2006
PEDIATRICS Vol. 117 No. 4 April 2006, pp. e711-e716 (doi:10.1542/peds.2005-1161)
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Epidemiology, Outcomes, and Costs of Invasive Aspergillosis in Immunocompromised Children in the United States, 2000

Theoklis E. Zaoutis, MD, MSCEa,b, Kateri Heydon, MSa, Jaclyn H. Chu, MHSa, Thomas J. Walsh, MDc and William J. Steinbach, MDd

a Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
b Department of Pediatrics and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
c Immunocompromised Host Section, Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
d Division of Pediatric Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina

OBJECTIVE. Invasive aspergillosis (IA) is the most common filamentous fungal infection observed in immunocompromised patients. The incidence of invasive aspergillosis has increased significantly in recent decades in parallel with the increasing number and improved survival of immunocompromised patients. IA in adults has been well characterized; however, only a few small studies of IA in children have been reported. Therefore, the objective of this study was to describe the incidence and outcomes of children with IA

METHODS. We performed a retrospective cohort study using the 2000 Kids Inpatient Database, a national database of hospital inpatient stays during 2000. IA was defined as aspergillosis that occurred in a child with malignancy (solid tumor, leukemia, or lymphoma), hematologic/immunologic deficiency, or transplant (bone marrow or solid organ). Discharge weighting was applied to the data to obtain nationally representative estimates of disease.

RESULTS. During 2000, there were an estimated 666 pediatric cases of IA among 152231 immunocompromised children, yielding an annual incidence of 437/100000 (0.4%) among hospitalized immunocompromised children. Children with malignancy accounted for the majority (74%) of cases of IA. The highest incidence of IA was seen in children who had undergone allogeneic bone marrow transplantation (4.5%) and those with acute myelogenous leukemia (4%). The overall in-hospital mortality of immunocompromised children with IA was 18%. Children with malignancy and IA were at higher risk for death than children with malignancy and without IA. Pediatric patients with IA had a significantly longer median length of hospital stay (16 days) than immunocompromised children without IA (3 days). The median total hospital charges for patients with IA were $49309 compared with immunocompromised children without IA ($9035).

CONCLUSIONS. The impact of IA on increases in mortality, length of hospital stay, and the burden of cost in the hospital setting underscores the need for improved means of diagnosis, prevention, and treatment of IA in immunocompromised children.

Key Words: aspergillosis • fungal Infections • pediatric • Aspergillus

Abbreviations: IA—invasive aspergillosis • BMT—bone marrow transplant • AHRQ—Agency for Healthcare Research and Quality • KID—Kids Inpatients Database • ICD-9-CM—International Classification of Diseases—Ninth Revision—Clinical Modification • CGD—chronic granulomatous disease • GVHD—graft-versus-host disease • IQR—interquartile range • AML—acute myelogenous leukemia • RR—relative risk • CI—confidence interval • ALL—acute lymphocytic leukemia • CNS—central nervous system • ABPA—allergic bronchopulmonary aspergillosis

Accepted Sep 27, 2005.




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