[Surgical antibiotic prophylaxis's usage review in a mother-child university hospital]. / Revue de l'utilisation de l'antibioprophylaxie en chirurgie pédiatrique dans un centre hospitalier universitaire mère­enfant.

OBJECTIVES: The main objective was to evaluate the surgical antibiotic prophylaxis's compliance rate. The secondary objectives were to evaluate the tools designed to help the surgical antibiotic prophylaxis's prescription, and evaluate the surgical site infection rate. METHODS: This retrospective study was done in a university hospital on a random selection of 125 pediatric patients having undergone a surgery (cardiac, general, neurological, ENT, orthopedic or plastic). Compliance to the current recommendations has been assessed. RESULTS: Out of the 125 studied patients (2 exclusions), the indication was compliant at 87% (107/123). The perioperative document included an intention to use antibiotic prophylaxis in 24% of cases (29/123). The compliance for the presence of the standard order set for antibiotic prophylaxis was only 15% (19/123). The compliance for the preoperative administration varied: antibiotic choice (94%, 63/67), dose (91%, 61/67), route (99%, 66/67), timing (30%, 20/67). The compliances for intra- and postoperative administrations were respectively 75% (57/76) and 89% (68/76). The surgical site infection rate was 4% (5/123). CONCLUSIONS: The use of a standard order set for antibiotic prophylaxis and the timing of the preoperative administration were sub-optimal. A better dissemination and use of the administrative tools and the implementation of a coordination system with the members of anesthesia services would improve these important aspects of the surgical antibiotic prophylaxis. The establishment of a digital perioperative document is planned.

[Exploration of the evolution of antibiotic consumption according to the WHO AWaRe classification, in a mother-child university hospital]. / Exploration de l'évolution de la consommation d'antibiotiques d'un centre hospitalier universitaire mère-enfant selon la classification AWaRe de l'Organisation mondiale de la santé.

BACKGROUND: Different measures of antimicrobial are used to ensure proper usage, as part of structured antimicrobial stewardship programs. OBJECTIVE: The main objective of this study is to describe the consumption of antibiotics in a mother-child teaching hospital using the AWaRe classification over a period of 15 years. METHODS: This descriptive and retrospective study included all the data on antibiotic consumption of patients admitted to mother-child University Hospital from April 1st 2005 to March 31st, 2021. Of the 180 international non-proprietary names of antibiotics proposed by the World Health Organization (WHO), 54 were used. The number of days of treatment (DOT) per 1000 patient-days (PD) was calculated per year, per patientele (e.g. surgery, pediatrics, oncology, intensive care, neonatal intensive care, nursery, psychiatry, rehabilitation and obstetrics and gynecology) and globally. The data was classified per the WHO AWaRe classification. RESULTS: A total of 10,489 DOT/1000PD were used globally in 15 years, corresponding to 53.9% of the "Access" group, 45.2% of the "Watch" group and 0.9% of the "Reserve" group. A reduction in the use of antibiotics was noted. The ratios of antibiotic consumptions in DOT/1000PD of 2020-2021 to 2005-2006 were 0.84 globally (1713/5653), 0.79 for the "Access" group (286/361), 0.89 for the "Watch" group (270/302) and 0.88 for the "Reserve" group (2.1/2.4). CONCLUSION: The AWaRe classification was used to describe the consumption of antibiotics in a mother-child center. Our consumption compared favorably with international data and is in line with the WHO targets. This position may be linked to the presence of a structured anti-biogovernance program that has been in place for several years within our hospital. More work is needed to more precisely identify the antibiotics that should benefit from better supervision.

Antibio-gouvernance en néonatalogie.

Rational use of antibiotic has become a national and international health priority to fight against the emergence of multiresistant bacteria. Neonates are particularly exposed to antibiotic treatments because of their high susceptibility to severe infection and the lack of specificity of sepsis signs that make diagnosis difficult. This population is also particularly susceptible to microbiota disruption due to antibiotic treatment. Implementation of antibiotic stewardship in neonate is then an urgent need. According to a literature review, principles of antibiotic stewardship implementation in neonate are based on: (i) a multidisciplinary team comprising infectious disease specialists and aware of neonatal specificities (diagnosis, bacterial epidemiology, pharmacology) ; (ii) clear and easy-to-evaluate goals discussed a priori with neonatologists ; (iii) short-term assessment of the impact on antibiotic consumption and antimicrobial resistance ; (iv) enablement of the healthcare professionals within the ward to enhance the sustainability and (v) support from the institution.

[Antibiotic consumption and bacterial sensitivity in a teaching hospital: A 5-year study]. / Profil de consommation et de sensibilité aux antibiotiques utilisés dans un centre hospitalier universitaire : étude rétrospective sur cinq ans.

INTRODUCTION: To reduce risks of antibiotic resistance, governmental and learned societies decreed the optimal use of antibiotics. The relation between antibiotic consumption and bacterial resistance increase has been clearly demonstrated over the last several years. Antibiotic consumption data and bacterial sensitivity data are regularly published, but very few publications have searched for a correlation between these two variables. This study focused on antibiotic use and consumption as well as bacterial sensitivity to these antibiotics. OBJECTIVES: The main objective was to describe the changes in antibiotic consumption and bacterial sensitivity in a mother-child teaching hospital. The secondary objectives were to explore whether antibiotic use and bacterial sensitivity were correlated and to comment on the usefulness of these data for clinicians. METHODS: This was a 5-year retrospective, descriptive, cross-sectional study. All samples from usually sterile biologic liquids of hospitalized pediatric patients were included in the study. The samples from outpatient clinics were excluded. All types of bacteria identified in more than 30 isolates were included in the study. The antibiotics usually used to treat these bacteria were included. To assess antibiotic consumption, we calculated the number of days of therapy per 1000 patient-days for hospitalized pediatric patients and we calculated the Pearson correlation coefficient between antibiotic consumption and sensitivity rates to these antibiotics. Two scenarios were explored: one with correlation by year and one with the next year for bacterial sensitivity. RESULTS: During the study period (2010-2011 to 2014-2015), overall antibiotics consumption remained relatively stable. Concerning bacterial sensitivity, we noted important changes (sensitivity rates increased for 12 antibiotic-bacteria pairs, remained stable for five, and decreased for 15). We found three significant correlations for the first scenario: Pseudomonas aeruginos-ceftazidime (P=0.01), P. aeruginosa-ciprofloxacin and fluoroquinolone consumption (P=0.02), Enterococcus sp-ampicillin and penicillin consumption (P=0.04). For the second scenario, we found only two significant correlations: coagulase-negative Staphylococcus-oxacilline and penicillin consumption (P=0.02), P. aeruginosa/piperacillin (P=0.04). CONCLUSION: This exploratory study allowed us to describe antibiotic consumption and bacterial sensitivity progression. To our knowledge, this is the first study exploring the correlation between antibiotic consumption and the bacterial sensitivity rate in pediatrics in Canada. It remains very difficult to show this correlation between these two variables because of the multiple sources of bacterial resistance. These data are particularly useful for the antimicrobial stewardship programs and for clinicians.

Delay in diagnosis of imported Plasmodium falciparum malaria in children.

The study reported here prospectively evaluated the time-to-diagnosis of imported Plasmodium falciparum malaria in children in seven French pediatric emergency departments during a 1-week period. For the 29 patients included, the mean patient, doctor and total delays were 3.1, 1.5 and 4.7 days, respectively. The late medical diagnosis for 11 patients was mainly due to the treating physician's failure to consider malaria, despite having been informed that the child had been in an endemic area, and erroneously making a diagnosis of viral infection. The five patients who were diagnosed correctly without delay had higher mean platelet counts than the others (206,000 vs 118,541/mm(3); p=0.008). The results indicate that greater awareness of the risk of malaria in returning travelers may help reduce delays in diagnosis and its consequences.

[Antibiotic therapy for lower tract infections in children]. / Antibiothérapie des infections respiratoires basses de l'enfant.

Lower respiratory tract infections in children encompass mainly bronchiolitis and community acquired pneumonia. Severity of bronchiolitis is linked to the intensity of the respiratory distress and young age. This syndrome is caused by viral infection, thus, initial antibiotherapy is not justified. In community acquired pneumonia, prognostic is dependent on the nature of the infective agent. Eventhough viruses are mainly responsible for the illness, bacterial (and particularly pneumococcal) agent cannot be ignored. Initial antibiotics must be efficient on Streptococcus pneumoniae.

[Fast diagnostic tests in the management of group A beta-heamolytic streptococcal pharyngitis]. / Tests de diagnostic rapide dans la prise en charge des angines à streptocoques bêta-hémolytiques du groupe A.

OBJECTIVE: Routine clinical diagnosis of Streptococcus pyogenes in pharyngitis is not always easy. The use in common practice of rapid diagnosis test (RDT), might offer a best control of the antibiotic treatments. The aim of this study is to present seven rapid diagnosis tests, to assess their feasibility and finally to determine the bacteriological correlation. METHOD: We propose to compare the results obtained with seven RDT, and to assess their interest in medical diagnosis for group A streptococcus pharyngitis. A prospective study was conducted for three months, a RDT was performed for children (n=75) between eight and fourteen years old presenting acute pharyngitis. Several throat sampling were performed to order cultures. RESULTS: The group A streptococcus was isolated in 33% (n=25) of throat sampling. Comparing cultures results, and for all studied tests, we obtained comparable performances with manufacturer data, specificity upper than 94% and sensitivity upper than 88%. CONCLUSION: All assessed RDT may offer to physicians a decision-making tool for rapid diagnosis. However, because of its complexity, the agglutination test can be used only in pathology laboratories.

Multicentre study of the molecular epidemiology, serotypes and antimicrobial susceptibility patterns of invasive Streptococcus pneumoniae invasive isolated from children in the Ille de France area.

Between January 1997 and April 2002, 73 consecutive invasive strains of Streptococcus pneumoniae were isolated from children under 16 years of age in four hospitals in suburban Paris. Their genetic diversity was investigated by serotyping and analysis of pulsed-field gel electrophoresis restriction patterns. Antibiotic susceptibility patterns were analysed by disk susceptibility testing and determination of minimal inhibitory concentrations. The genetic basis of macrolide resistance was investigated by polymerase chain reaction. Studies of penicillin and vancomycin tolerance were performed for each strain. Despite the high prevalence (45.2%) of penicillin-nonsusceptible Streptococcus pneumoniae, resistance to amoxicillin (1.4%) was rare, and no strain was resistant to cefotaxime. Overall, 4.1% of pneumococcal strains were resistant to penicillin. Penicillin or vancomycin tolerance was not detected in any of the 73 strains studied. Of the erythromycin-resistant strains (48%), all but one carried the ermB gene. No strains showing a decreased susceptibility to ciprofloxacin (MIC, >4 mg/l) or overexpressing an efflux pump inhibited by reserpine were isolated. The serotypes found, in order of frequency, were as follows: 18C, 14, 6B, 19F, 19A, 9V, 23F, 1, 7F, 9A, 38. Strains of penicillin-nonsusceptible Streptococcus pneumoniae belonged predominantly to serotypes 14, 6B, 9V, 9A, 23F, 19F and 19A. The seven-valent conjugated vaccine covered 85.5% of the serogroups isolated in children under 2 years of age and 65.6% of the serogroups identified in children over 2 years of age. The genetic analysis showed a high identity for some serotypes, such as 14/9V, 6B and 23F. The use of the seven-valent conjugated vaccine is a critical measure to prevent invasive pneumococci infections in children in the Ille de France area.

[Compliance with the vaccination recommendations for 0- to 24-month-old infants in general or paediatric practice]. / Suivi des recommandations vaccinales des nourrissons de 0 à 24 mois: à propos d'une enquête en médecine libérale.

PURPOSE: To describe the vaccine practice of general practitioners and paediatricians for the 0-24-month-old infants and their deviations to the official recommendations. RESULTS: One thousand three hundred and fifty-five practitioners, 46 +/- 8-year-old took part in the survey. Among them 42.7% were general practitioners and 57.3% were paediatrician. Only one third of them, strictly complied with the official vaccination recommendation (33.1%). This percentage was higher for the general practitioners (43.4%) than for the paediatricians (25.5% P < 0.001). When practitioners adapted the vaccination program, their modifications essentially concerned the first administration of the DTCP Hib vaccine, which was delayed of 1 or 2 months. Some vaccines were specifically concerned by the modifications. The ROR was delayed and the vaccination coverage reached only 75% at 18 months. General practitioners adapted the vaccination calendar more often than paediatricians (16.9 vs. 9.0%: P < 0.05). The B Hepatitis vaccination schedule was the most frequently adapted one by general practitioners as well as paediatricians to deal with multiple injections (53.5%), and the age of the infants (39.1%). CONCLUSION: The availability of hexavalent vaccination containing B Hepatitis should contribute to increase the vaccination coverage of the population against B Hepatitis and could allow an antipneumococcal vaccination through an heptavalent vaccine without increasing the number of injections. On the other hand, general practitioners and paediatricians must actively contribute to increase the ROR vaccination coverage.

[Mortality due to Streptococcus pneumoniae infection in children. A 5-year retrospective study in Ile-de-France]. / Mortalité par infections à Streptococcus pneumoniae chez l'enfant. Etude rétrospective sur cinq ans en Ile-de-France.

Streptococcus pneumoniae is the leading cause of community acquired infections. We conducted a 5 years retrospective study to assessed mortality of pneumococcal infections in children in the area of Paris. Regarding the provided answers, the mortality rate is 0.3/100.000/year in the 0-15 years old children. The majority of them are toddlers. Only 30% of cases occurred in high-risk children. Meningitis was the main cause of death. Pneumococcal resistance to antibiotics did not appear as a risk factor of mortality.

[Secondary effects of vaccinations]. / Effets secondaires des vaccinations.

The adverse effects of vaccines include local reactions and systemic symptoms or illnesses. Local reactions are frequent, most often presenting as transient pain, redness, edema and/or nodule. Fever of short duration is the main systemic symptom, generally occurring within 24-48 hours following vaccination. Some vaccines have recognized specific adverse effects such as thrombocytopenic purpura for the measles-mumps-rubella vaccine, and febrile convulsions for the pertussis vaccine. Hepatitis B vaccine and Haemophilus influenzae type b vaccine have been respectively suspected to be responsible for neurological demyelinating disease and insulin-dependent diabetes mellitus, but large-scale epidemiological studies have failed to confirm these allegations.

Current approaches to otitis media.

Acute otitis media is the most commonly diagnosed illness in children, and is one of the most common reasons for antibiotic prescription. In many countries, antibiotic resistance is increasing among the bacteria that are implicated in acute otitis media, particularly Streptococcus pneumoniae. This evolution should stimulate changes in the management of acute otitis media, particularly the following: improvement in diagnostic accuracy; reduction in antibiotic use; selection of the most appropriate drugs at the appropriate dosage; reduction in duration of treatment, when possible; and implementation of new vaccines.

[Marshall syndrome: results of a retrospective national survey]. / Syndrome de Marshall: résultats d'une enquête nationale rétrospective.

Marshall's syndrome or periodic fever syndrome was first described in 1987 in the USA based on observations of 12 children under the age of five with periodic fever (> 38 degrees C) and accompanying aphtous stomatitis, pharyngitis, and cervical adenopathy (PFAPA). In 1998, a national retrospective study was carried out in France by the pediatric infectious pathology group, and a semeiological analysis was made of 22 cases. The main characteristics of Marshall's syndrome found in this patient population were in agreement with those reported in the literature. The onset of symptoms occurred between the age of 3 months and 12 years, with a mean age of 5 years; no geographical or ethnic predisposing factors were noted. The diagnosis of symptoms was subsequently established at an age ranging from 5 months to 16 years, with a mean age of 6.5 years. It was determined that following an initial phase of generalized clinical manifestations (asthenia, cranial neuritis, dysphagia, anorexia), the symptoms become stereotyped, with the sudden appearance of high fever (> 40 degrees C), shivering, aphtous stomatitis, pharyngitis, and cervical adenopathy. Other symptoms such as cranial neuritis, arthralgia, and abdominal pain may also be present (50% of cases in the present study), but due to their variability of appearance they are of lesser diagnostic value. The main characteristic of Marshall's syndrome is its periodic aspect; with fever occurring every 6 to 9 weeks, with a mean interval of 66 days before recurrence of fever compared to the shorter interval of 21 to 28 days reported in the literature. After excluding the presence of an infection, the differential diagnosis includes the following: familial Mediterranean fever, hyper IgD syndrome, and feverish neutropenia. During the periods of fever, an inflammatory syndrome with hyperleucocytosis and a marked increase in C-reactive protein (CRP) levels and sedimentation rate is observed. The most effective treatment seems to be the early administration of corticoids during the initial phase, prior to the appearance of more specific symptoms. The prognosis is excellent, with a progressive decrease in the incidence of periodic fever and an absence of complications. However, the etiology of Marshall's syndrome has not yet been determined.

[Recurrent otitis: what is the place of complementary examinations]. / Otites récidivantes: quelle place pour les examens complémentaires?

Recurrent otitis media is defined by the occurrence of three episodes of acute otitis media in a year. Several risk factors are now well recognized, particularly the occurrence before six months of age of a first episode of otitis media, day care centers, and upper respiratory tract infections (rhinopharyngitis). In most cases biological or radiological investigations are of little interest. They are only indicated in case of persistent recurrent episodes, despite eviction of all risk factors and adenoidectomy, and mainly in case of association with bronchopulmonary pathology.

[Prevention of antibiotic resistance needs informed parents]. / La lutte contre la résistance aux antibiotiques passe aussi par l'information aux parents.

Antibiotic resistance is becoming worldwide a major challenge. Increasing rate of multidrug resistant bacteria is directly linked with the consumption of antibiotic. Children are the greatest consumers of antibiotics, but this large pediatric prescription is not justified, and responds, at least in part, to a "parental pressure". Therefore information to the parents about antibiotic is recommended. In order to promote this information the American Academy of Pediatrics recently wrote a booklet entitled "Your child and antibiotics" which is presented.

[Acute tonsillitis: towards a new therapeutic strategy]. / Angines aiguës: vers une nouvelle stratégie thérapeutique.

There is a need for revising the current practice for treatment of acute tonsillitis in France, i.e., systematic antibiotic treatment. There are three main reasons for this revision: 1) group A betahemolytic streptococcus is involved in only 20% of acute tonsillitis (80% being viral); 2) rheumatic fever has become very rare; 3) efficient rapid diagnostic tests are now available, allowing a selection of patients with streptococcal tonsillitis who must be treated.

[Immunization schedule in the European Union]. / Calendriers vaccinaux au sein de l'union européenne.

All nations that are part of the European Union share the same aim for the control and eradication of vaccine-preventable diseases. However, there are differences in child immunization strategies and schedules between nations, depending upon health care systems, immunization habits and epidemiology of infectious diseases. All nations immunize children against diphtheria, tetanus, poliomyelitis, measles, rubella and mumps. Immunization against pertussis, Haemophilus influenzae, hepatitis B and tuberculosis are not systematically applied.