Management of invasive fungal diseases (IFDs) in children with cancer varies widely across pediatric oncology centers in Germany, Austria, and Switzerland, according to new data presented at IDWeek 2025, in Atlanta (abstract P-471).
The analysis, led by Danila Seidel, PhD, who manages the global FungiScope registry for invasive fungal infections, surveyed pediatric oncology programs in the three countries to better understand current diagnostic practices, access to infectious diseases expertise, antifungal prophylaxis and treatment protocols, and availability of therapeutic drug monitoring (TDM).
“While international guidelines exist for the prevention, diagnosis, and treatment of IFDs, pediatric-specific evidence remains limited and practices vary,” noted Dr. Seidel, a researcher at the University Hospital of Cologne, in Germany.
Different Practices in Different Centers
Between June and September 2024, 72 centers affiliated with the German Society for Paediatric Oncology and Haematology were invited to participate, with 62 completing the survey for an 86% response rate. Fifty-one centers were located in Germany, five in Austria, and six in Switzerland. The median number of new oncology cases per center in 2023 was 56, and more than half (55%) also performed hematopoietic stem cell transplantation. Nearly 9 in 10 centers (89%) reported at least one proven or probable IFD, with a median incidence of 4.6%.
Access to pediatric ID specialists varied significantly. All Swiss centers reported the availability of ID support, compared with only 51% of German and 40% of Austrian sites, for an overall rate of 58%. Just 24% of centers offered round-the-clock ID consultation. Larger centers were significantly more likely to have an ID specialist (P=0.008) and to maintain formal antifungal standard operating procedures (P=0.02).
Testing
All centers performed fungal culture and histopathology, with 94% using galactomannan testing, 86% using polymerase chain reaction assays, and 53% using beta-D-glucan testing. However, access to in-house TDM remained inconsistent, with on-site monitoring available at only 52% of centers for voriconazole (Pfizer) and at even fewer centers for posaconazole (Merck) and isavuconazonium (Astellas).
Therapies
Prophylaxis strategies also differed. Liposomal amphotericin B (Gilead) was used most frequently across risk groups and remained the preferred first-line treatment for invasive pulmonary aspergillosis (71% of centers) and for candidemia (45%), followed by voriconazole and echinocandins.
A Need for ID Support
Considerable heterogeneity persists in IFD management across pediatric oncology centers in the region, the authors concluded, with center size and the availability of ID resources appearing to strongly influence the consistency of care. Reported gaps included limited 24/7 ID support, inconsistent or absent standard operating procedures, and incomplete access to TDM.
“Our findings show that strengthening oncology-ID collaborations, standardizing SOPs, and enhancing antifungal stewardship, potentially via digital platforms, may harmonize care and improve outcomes for children at risk of invasive fungal disease,” Dr. Seidel said.