Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2025 Aug 1;47(6):e222-e230.
doi: 10.1097/MPH.0000000000003070. Epub 2025 Jun 20.

Antifungal Use in Immunocompromised Children in Europe: A 12-Week Multicenter Weekly Point Prevalence Survey (CALYPSO)

Elisavet Chorafa  1 , Elias Iosifidis  1 , Andrea Oletto  2 , Adilia Warris  3   4 , Elio Castagnola  4   5 , Roger Bruggemann  4   6 , Andreas H Groll  4   7 , Thomas Lehrnbecher  4   8 , Laura F Antolin  3   4   9 , Alessio Mesini  4   5 , Aisha A Alkhaaldi  10 , Fernando Baquero-Artigao  11 , Benhur S Cetin  12 , Daniel Ebrahimi-Fakhari  7 , Marieke Emonts  13   14 , Susanna Esposito  15 , Valentina Fainardi  15 , Elisabetta Ghimenton-Walters  13 , Manuel Gijón  16 , Alba G Guerrero  17 , Carlos D Grasa  11 , Igne Kairiene  18   19 , Kornelija Kildonaviciute  20 , Maria Kourti  1 , Angela Manzanares  16 , Natalia Mendoza-Palomar  21 , Maria Noni  22 , Eugenia Papakonstantinou  23 , Stéphane Paulus  20 , Thomas Perwein  24 , Jelena Rascon  18   19 , Elena Rincón-López  17   25 , Pere Soler-Palacin  21 , Galina Solopova  26 , Vassiliki Spoulou  22 , Volker Strenger  24 , Kara Tedford  10 , Christina Tzika  1 , Borbala Zsigmond  27 , Emmanuel Roilides  1   4
Affiliations
Multicenter Study

Antifungal Use in Immunocompromised Children in Europe: A 12-Week Multicenter Weekly Point Prevalence Survey (CALYPSO)

Elisavet Chorafa et al. J Pediatr Hematol Oncol. .

Abstract

We prospectively analyzed antifungal use in immunocompromised children through a multicenter 12-week weekly point-prevalence survey in 31 hematology-oncology (HO) and hematopoietic stem cell/solid organ transplant (HSCT/SOT) units of 18 hospitals in 11 European countries. All patients hospitalized and receiving systemic antifungals were included. Ward policies, and weekly ward/patient data were collected. All 21 HO and 10 HSCT/SOT units had prophylaxis policies for high-risk patients (27/31 used azoles, 14/31 echinocandins and 15/31 liposomal amphotericin B [LAMB]). Among 572 courses recorded, prophylaxis was indicated in 439/572 (77%) and treatment in 133/572 (62/133 empirical, 43/133 pre-emptive, 28/133 targeted). Among patients receiving prophylaxis, 56% belonged to the non-high-risk group. Most common reasons for empirical, pre-emptive and targeted treatment were antibiotic-resistant febrile neutropenia (52%), abnormalities on chest-CT with/without positive galactomannan (77%) and candidiasis (82%), respectively. Fluconazole and LAMB were the most frequently prescribed agents both for prophylaxis (31%, 21%) and treatment (32%, 23%). Underdosing of micafungin for treatment in 50% of prescriptions and of fluconazole for treatment and prophylaxis in 70% of cases was noticed. In conclusion, most antifungal prescribing was for prophylaxis, with fluconazole being the main antifungal prescribed. Inadequate doses of antifungal prescribing and prophylaxis of non-high-risk patients could be targets for improvement.

Keywords: antifungal agents; antifungal prescriptions; antifungal stewardship; antifungal use; immunocompromised patients.

PubMed Disclaimer

Conflict of interest statement

E.C.: Speaker at sponsored symposia for Pfizer, Gilead and F2G; data safety review committee for Mundipharma. C.G. is funded by the Spanish Ministry of Science and Innovation—Instituto de Salud Carlos III and Fondos FEDER (Contrato Juan Rodés JR22/00044). A.H.G. has received grants from Gilead, Merck, Sharp & Dohme and Pfizer and has served as a consultant to Amplyx, Astellas, Basilea, F2G, Gilead. Merck, Sharp & Dohme, Pfizer, Scynexis, and Mundipharma. T.L. has received a grant from Gilead Sciences, has served as a consultant to Gilead Sciences, Merck/MSD, Pfizer, Astellas, AstraZeneca, Recordati and Roche, and served at the speaker’s bureau of Gilead Sciences, Merck/MSD, Astellas, Pfizer and GSK and Recordati. E.R. has received research grants from Merck, Abvie, Shionogi, Cidara and Pfizer Inc. to his institution and is a scientific advisor and member of the speaker bureaux for Gilead, Merck, Shionogi, Mundipharma, and Pfizer Inc. V.S. has served as a consultant for GSK, Pfizer, and Merck/MSD, and is a part of the speaker´s bureau of GSK, Pfizer, and Merck/MSD. A.W. has received consultant fees from Gilead and Mundipharma and payment for educational events from Gilead and F2G. P.S.-P. has received grants from Gilead and Pfizer and has served as a consultant to Gilead. Merck, Sharp & Dohme and Pfizer. N.M.-P. has received grants from Gilead and has served as a consultant to Pfizer, and spoke at sponsored symposia for Pfizer and Gilead. R.B. has served as a consultant to Astellas Pharma, Inc., Basilea, F2G, Scynexis, Gilead Sciences, Mundipharma, and Pfizer, Inc., and has received unrestricted and research grants from Astellas Pharma, Inc., Gilead Sciences, and Pfizer, Inc. All contracts were through Radboudumc, and all payments were invoiced by Radboudumc. The remaining authors declare no conflict of interest.

References

    1. Kourti M, Chorafa E, Roilides E, et al. Antifungal stewardship programs in children: challenges and opportunities. Pediatr Infect Dis J. 2023;42:e246–e248.
    1. Pana ZD, Roilides E, Warris A, et al. Epidemiology of invasive fungal disease in children. J Pediatric Infect Dis Soc. 2017;6(suppl_1):S3–S11.
    1. Vazquez L. Antifungal prophylaxis in immunocompromised patients. Mediterr J Hematol Infect Dis. 2016;8:e2016040.
    1. Johnston DL, Lewis V, Yanofsky R, et al. Invasive fungal infections in paediatric acute myeloid leukaemia. Mycoses. 2013;56:482–487.
    1. Fisher BT, Robinson PD, Lehrnbecher T, et al. Risk factors for invasive fungal disease in pediatric cancer and hematopoietic stem cell transplantation: a systematic review. J Pediatric Infect Dis Soc. 2018;7:191–198.

Publication types

Substances

LinkOut - more resources