Didier Stamm

High-dose albuterol by metered-dose inhaler plus a spacer device versus nebulization in preschool children with recurrent wheezing: A double-blind, randomized equivalence trial.

Inhaled albuterol is the most frequently used bronchodilator for acute wheezing, and nebulization is the standard mode of delivery in hospital setting. However, recent guidelines consider spacer devices as an easier to use, and cost-saving alternative and recommend the high-dose metered-dose inhaler bronchodilator. Objective. To demonstrate clinical equivalence between a spacer device and a nebulizer for albuterol administration. Design. Randomized, double-blind, parallel group equivalence trial. Setting. Pediatric emergency wards at 2 tertiary teaching hospitals. Patients. Sixty-four 12- to 60-month-old children with acute recurrent wheezing (32 per group). Interventions. Albuterol was administered through the spacer device (50 μg/kg) or through the nebulizer (150 μg/kg) and repeated 3 times at 20-minute intervals. Parents completed a questionnaire. Outcome Measures. Pulmonary index, hospitalization, ease of use, acceptability, and pulse oximetry saturation. Results. The 90% confidence interval of the difference between treatment groups for the median absolute changes in pulmonary index values between T0 and T60 was [−1; +1] and was included in the equivalence interval [−1.5; +1.5]. Clinical improvement increased with time. Less than 10% of the children (3 in each group) required hospitalization (2 in each group attributable to treatment failure). Parents considered administration of albuterol using the spacer device easier (94%) and better accepted by their children (62%). Conclusions. The efficacy of albuterol administered using the spacer device was equivalent to that of the nebulizer. Given its high tolerance, repeated 50-μg/kg doses of albuterol administered through the spacer device should be considered in hospital emergency departments as first-line therapy for wheezing.

Prompt and Successful Toxin-Targeting Treatment of Three Patients with Necrotizing Pneumonia Due to Staphylococcus aureus Strains Carrying the Panton-Valentine Leukocidin Genes

ABSTRACT Three patients with extensive necrotizing pneumonia due to Panton-Valentine leukocidin-positive Staphylococcus aureus strains and with aggravating factors (leukopenia count of less than 3 × 109/liter in all three cases and hemoptysis in two cases) were successfully treated with toxin-suppressing agents introduced rapidly after hospital admission.

Postoperative infectious complications in paediatric liver transplantation: a study of 48 transplants

We studied, retrospectively, postoperative infectious complications following paediatric liver transplantation at a single university centre. The objectives were to characterize the epidemiology of infection and to determine the associated risk factors during the early postoperative period, either the first postoperative month or the entire duration of paediatric intensive care unit (PICU) stay. Forty‐eight liver transplants were performed on 46 patients. Sixty‐three infections occurred in 32 patients who underwent 34 liver transplantations (1.36 infection/patient); 47 were bacterial, 6 fungal and 10 viral. The most common sites of infection were bloodstream (36.5%) and abdomen (30%). Gram‐positive bacteria (78%) predominated over gram‐negative bacteria (22%). Initial analysis revealed infection risk factors to be age <1 year, body weight <10 kg, extrahepatic biliary atresia, intraoperative transfusion > 160 ml·kg−1, mechanical ventilation > 8 days and PICU stay > 19 days. After stratified analysis, the main risk factor for infection was low body weight of the recipient.

Outcome of cadaver kidney transplantation in small children

Cochat P, Castelo F, Glastre C, Martin X, Stamm D, Long D, Lavocat M‐P, Hadj‐Aïssa A, Lyonnet D, Floret D. Outcome of cadaver kidney transplantation in small children. Acta Pædiatr 1994;83:78–83. Stockholm. ISSN 0803–5253

Procalcitonin can Fail to Rise in Severe Bacterial Infections 69

Background: high Procalcitonin (pro-CT) plasma concentrations(> 9-10 μg/l), following cytokines release, seem to be an early marker of severe Bacterial Infections (BI). Lower concentrations are found in viral infections. We evaluated early pro-CT concentrations in course of severe pediatric BI. Subjects: 12 children (5′ days-16 years); diagnosis of sepsis, septic shock and bacterial meningitis (positive blood and/or CSF cultures). Interventions: pro-CT (ImmunoLuminescent Assay), CRP, interleukin-6 (IL6) and tumour necrosis factor α(TNFα) (ELISA) were measured on admission. Results: pro-CT concentrations were above 10 μg/l in all but 2 children (16,6%): a 1 month old girl (S. Virchow meningitis, pro-CT 0,36 μg/l, CRP 145 mg/l, IL6 14 pg/ml, TNFα <13 pg/ml) and a 6 month old boy (H. Influenzae meningitis, pro-CT 4,4 μg/l, CRP 103 mg/l, IL6 20 pg/ml, TNFα < 13 pg/ml). In both pro-CT concentrations remained low and CRP rapidly fell below 10 mg/l under antibiotic treatment. Conclusions: we speculate that pro-CT concentrations can fail to rise above 10 μg/l in a number of bacterial meningitis maybe due to low bacterial concentrations.