RETROSPECTIVE ANALYSIS OF YEAST COLONIZATION AND INFECTIONS IN PEDIATRIC BONE-MARROW TRANSPLANT RECIPIENTS

Sixty-four pediatric patients who underwent allogeneic (n = 35), autol ogous (n = 28) or syngeneic (n = 1) bone marrow transplantation (BMT) between 1992 and 1994 were evaluated retrospectively. As antifungal pr ophylaxis, all patients received amphotericin B tablets and 62 of 64 ( 96.9%) received oral fluconazole. Weekly surveillance cultures reveale d fungal colonization in 35 patients (54.7%). Six patients (9.4%) were colonized before BMT only, 17 (26.6%) after BMT only and 12 (18.8%) b oth before and after BMT. Candida albicans was the most frequently iso lated fungus [21 of 46 fungal isolates (45.7%)], followed by C. glabra ta [14 isolates (30.4%)]. Non-albicans species of Candida were most fr equently isolated after BMT from the faeces, often in high numbers. Au tologous marrow recipients had a higher fungal colonization rate both before and after BMT than allogeneic marrow recipients. One patient su ffered from invasive pulmonary aspergillosis after BMT. No fungaemis o r deep-seated yeast infections were observed. Six of the seven patient s who had to be treated with intravenous amphotericin B because of ant ibiotic-refractory fever had undergone autologous BMT. Multivariate an alysis of various parameters showed only pre-BMT yeast colonization to be independently associated with post-BMT colonization. Thus, systemi c mycoses occurred only rarely in this study population; however yeast colonization after BMT (especially with non-albicans species) was a f requent in spite of double prophylaxis with oral amphotericin B and fl uconazole.