Child/Adolescent Health

Fungal infections in immunocompromised children dramatically increase mortality rate, length of hospital stay, and costs

Some children's immune systems are compromised by diseases such as cancer or treatments such as bone marrow transplantation. The most common fungal infection to strike immunocompromised children, invasive aspergillosis (IA), dramatically increases their mortality rate, length of hospital stay, and care costs, according to a new study supported in part by the Agency for Healthcare Research and Quality (HS10399). During 2000, 0.5 percent of hospitalized immunocompromised children developed IA. Nearly one in five (18 percent) of these children died in the hospital. Children with malignant cancer accounted for the majority (74 percent) of IA cases. The highest incidence of IA was seen in children who had undergone allogeneic bone marrow transplantation (4.5 percent) and those with acute myelogenous leukemia (4 percent).

Children with cancer and IA had a 13.5 percent higher risk of dying in the hospital than children with cancer without IA (21 vs. 1 percent). The risk of dying from IA ranged from 13 to nearly 22 times greater in children with central nervous system malignancies, acute lymphocytic leukemia, and lymphoma than it was in children with similar cancers without IA.

Immunocompromised children with IA also had over 5 times longer median length of hospital stays (16 days) than their counterparts without IA (3 days), and over 5 times higher median total hospital charges ($49,309 vs. $9,035).

These findings are the first from a nationally representative study to examine IA-related outcomes and costs in immunocompromised children. They were based on retrospective analysis of hospital inpatient data from the 2000 Kids' Inpatient Database, part of AHRQ's Healthcare Cost and Utilization Project.

See "Epidemiology, outcomes, and costs of invasive aspergillosis in immunocompromised children in the United States, 2000," by Theoklis E. Zaoutis, M.D., M.S.C.E., Kateri Heydon, M.S., Jaclyn H. Chu, M.H.S., and others in Pediatrics 117, pp. 711-716, 2006.

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