S. Timsit

Apport du bromure d’ipratropium dans la prise en charge des crises d’asthme aux urgences

Background. – To determine if the addition of ipratropium bromide in the emergency department (ED) for the treatment of childhood asthma reduces rates of hospitalization and relapses for moderate and severe exacerbations. Methods. – Patients were given an oral corticosteroid treatment (2 mg/kg) and received every 20 minutes either three nebulizations with albuterol (0.15 mg/kg) and ipratropium bromide (250 μg) or six nebulizations with albuterol alone (control group). The primary end point was the need for hospitalization, additional nebulizations or a relapse during the following week. Secondary end point included the effect of age. Results. – One hundred and fourty three children, two to 15 years old, were randomized to ipratropium or control groups and 121 were evaluated on day seven. As a whole, the control group was less often hospitalized or in relapse than those treated with three nebulizations of albuterol and ipratropium (17.5% vs 37.9%, p <0.02). The ipratropium group reached the same result after three additional albuterol nebulizations. The benefit of anticholinergic therapy was observed for children less than six years of age who had a similar rate of success (73.5 vs 75.7%). Conclusion. – The association of ipratropium bromide to the first three doses of the albuterol protocol for acute asthma did not act as well as six nebulizations of albuterol alone. The effect was age dependent and two to six years old children needed more attention. Nevertheless the hospitalization rate did not support the use of ipratropium compared with repeated albuterol nebulizations.

Community-Onset Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae Invasive Infections in Children in a University Hospital in France.

AbstractLimited data is available on pediatric community-onset infections with extended-spectrum &bgr;-lactamase-producing Enterobacteriaceae (ESBL-PE), but such infections may affect both the efficacy of empiric antibiotic therapy and the rational use of antibiotics.We retrospectively analyzed data from 2007 to 2012 for all children ⩽16 years old with a positive ESBL-PE strain from usually sterile sites within 48 hours of admission in a tertiary hospital in France. We analyzed healthcare- and community-associated infections among community-onset infections. In total, 3612 Enterobacteriaceae isolates were collected; the prevalence of ESBL-PE infection increased over the study period, from 2.4% to 5.1% (P < 0.001). Among the 90 children with a first community-onset ESBL-PE infection, 58% (n = 52) had a healthcare-associated infection, and 87% of isolates were susceptible to amikacin. As compared with patients with community-associated infections, those with healthcare-associated infections had fewer urinary tract infections (UTIs) (86% vs 97%) and Escherichia coli infections (35% vs 84%) and more Klebsiella pneumoniae infections (46% vs 8%). Inappropriate empiric treatment was prescribed for 54 patients (64%), but a favorable outcome was observed in 46 of 49 (94%) and 1 of 5 (20%) patients with UTIs and non-UTIs, respectively (P < 0.001). Among patients with community-associated infections, 85% had at least 1 risk factor for ESBL-PE infections. In conclusion, the prevalence of community-onset ESBL-PE infections doubled during the study period. These infections mainly occurred among children with healthcare-associated criteria or identified risk factors. Amikacin is an alternative to carbapenems for empiric treatment because most of these infections involved urinary tract and susceptible isolates.

Extended-spectrum β-lactamase-producing bacteria caused less than 5% of urinary tract infections in a paediatric emergency centre

The last decade has seen a significant increase in extended‐spectrum β‐lactamase (ESBL) secreting organisms responsible for paediatric urinary tract infections (UTIs), particularly in community‐acquired infections. These expose patients to the risks of antibiotic treatment failure and renal scarring. This prospective study examined the prevalence and risk factors of febrile ESBL UTIs and their treatment in the paediatric emergency department of a university hospital.

SFP PC-57 - Infections urinaires fébriles à germe sécréteur de BLSE aux urgences pédiatriques

Objectifs Les infections urinaires febriles de l’enfant sont un motif frequent de consultation aux urgences pediatriques. Les protocoles de traitement doivent s’ajuster a l’epidemiologie locale. L’etude avait pour objectif de definir l’incidence aux urgences de l’hopital Necker des infections urinaires febriles (IU) a germe secreteur de BLSE de mai 2012 a avril 2013 et d’etudier des facteurs de risque definis precedemment dans la litterature. Sujets / materiels et methodes L’etude etait prospective, descriptive et monocentrique. Tous les enfants âges de moins de 16 ans ayant une histoire clinique compatible d’IU et un ECBU positif ont ete inclus. Resultats principaux 488 IU ont ete analysees, elles concernaient 460 enfants dont 92 (20%) avaient une uropathie. 23 (4,7%) etaient lies a un germe secreteur de BLSE dont 16 E.coli et 6 Klebsielles. Les facteurs de risque significatifs et independants d’IU a germe secreteur de BLSE etaient l’antecedent d’hospitalisation au cours des 6 derniers mois et l’uropathie chronique. Les penemes ont ete utilisees dans 4 cas et l’association cefixime-amoxicilline acide clavulanique 7 fois. L’evolution de ces infections a ete favorable dans tous les cas. Conclusion L’incidence des IU a germe secreteur de BLSE etait de 4,7%.

SFP P-101 - Infections communautaires invasives à Entérobactéries productrices de BLSE (EBLSE)

Objectifs Decrire l’epidemiologie des infections invasives communautaires (IIC) a EBLSE en pediatrie. Sujet/materiels et Methodes Etude retrospective monocentrique visant a identifier les patients Resultats principaux Parmi les 3612 souches d’enterobacteries isolees, 3,9% etaient productrices de BLSE avec une augmentation pendant la periode d’etude de 2,4 a 5,1%, p Conclusions Les IIC a EBLSE augmentent en frequence, conservent une bonne sensibilite a l’amikacine et sont majoritairement des IAS ou surviennent chez des enfants avec des FDR.