227: Fungal Infections: A Survey of Pediatric Survey of Pediatric Blood & Marrow Transplant Consortium Institutions

This survey was designed to identify the fungal infection management used for the pediatric BMT patient and to develop a standard of care for fungal infection management by institutions within the Pediatric Blood & Marrow Transplant Consortium (PBMTC). Twenty five percent of the surveys were returned. 100% of the institutions performed allogeneic and autologous transplants. Non-myeloablative transplants were performed by 89% of the institutions. All institutions used some type of fungal prophylaxis during transplant, 77% used fungal prophylaxis on all their transplant patients. 50% of the centers differed on the prophylaxis used in the BMT sub-groups, with 85% of the centers using Fluconazole, and 15% of the institutions using no prophylaxis in autologous patients. 100% of centers administered prophylaxis to the allogeneic transplant group. The break down of agents utilized in the allo-graft group was Fluconazole (47%), Voriconazole (23%) and low dose daily amphotericin (31%). Fungal prophylaxis was started pre-transplant at 85% of the institutions, day +1 (15%) of the institutions. Fungal prophylaxis was stopped with immunosuppressive therapy at 69% of the centers, day +21 (7%), day +100 (7%) and 17% of reporting institutions did not specify. Ninety-three percent of the institutions used prophylaxis for cGVHD patients. Fifty-percent routinely screen for fungal infections after day 0 in both autologous and allogeneic transplants, utilizing weekly culture surveillance (23%), fever only (25%), fever/clinical evidence (45%) and by Glactamann assay (7%). Fungal organisms screened for included Canididia (53%), Histoplasma (31%), Crytpotococcus (15%), Aspergillus (85%), Zygomyces (45%) and Fusarium (31%). The majority reported using hepa-filtered rooms and hand washing. N-95 masks (31%) were part of BMT isolation policy and 11% used gowns. There were age specific visitor restrictions at 50% of the institutions with no visitors under an age range of 12 to15 years old. Based on the submitted surveys the PBMTC institutions employ various fungal management practices. These findings suggest a need to develop a fungal management standard of care for the pediatric BMT patient. Further exploration of practices and outcomes is needed to expand evidence based fungal management practices in the pediatric BMT patient.