Sandra Biscardi

Mycoplasma pneumoniae and Asthma in Children

The aim of this prospective study of a population of children (age, 2-15 years) hospitalized for severe asthma was to test them for acute infection due to Mycoplasma pneumoniae and acute infection due to Chlamydia pneumoniae. Of 119 patients with previously diagnosed asthma, acute M. pneumoniae infection was found in 24 (20%) and C. pneumoniae infection was found in 4 (3.4%) of the patients during the current exacerbation. Of 51 patients experiencing their first asthma attack, acute M. pneumoniae infection was proven in 26 (50%) of the patients (P<.01) and C. pneumoniae in 4 (8.3%). In the control group of 152 children with stable asthma or rhinitis, 8 (5.2%) had M. pneumoniae infection (P<.005). Of the 29 patients experiencing their first asthma attack and infected with M. pneumoniae or C. pneumoniae, 18 (62%) had asthma recurrences but only 6 (27%) of the 22 patients who did not have such infections had asthma recurrences (P<.05). M. pneumoniae may play a role in the onset of asthma in predisposed children and could be a trigger for recurrent wheezing.

Early Impact of 13-Valent Pneumococcal Conjugate Vaccine on Community-Acquired Pneumonia in Children

BACKGROUND Pneumococcal serotypes 1, 3, 5, 7F, and 19A were the most implicated in community-acquired pneumonia (CAP) after implementation of 7-valent pneumococcal conjugate vaccine (PCV7). In France, the switch from PCV7 to 13-valent pneumococcal conjugate vaccine (PCV13) occurred in June 2010. An active surveillance network was set up to analyze the impact of PCV13 on CAP. METHODS An observational prospective study performed in 8 pediatric emergency departments from June 2009 to May 2012 included all children between 1 month and 15 years of age with chest radiography-confirmed pneumonia. Three 1-year periods were defined: pre-PCV13, transitional, and post-PCV13. RESULTS During the 3-year study period, among the 953 274 pediatric emergency visits, 5645 children with CAP were included. CAP with pleural effusion and documented pneumococcal CAP were diagnosed in 365 and 136 patients, respectively. Despite an increase (4.5%) in number of pediatric emergency visits, cases of CAP decreased by 16% (2060 to 1725) between pre- and post-PCV13 periods. The decrease reached 32% in infants in the same periods (757 to 516; P < .001). Between pre- and post-PCV13 periods, the proportion of CAP patients with a C-reactive protein level >120 mg/dL decreased from 41.3% to 29.7% (P < .001), the number of pleural effusion cases decreased by 53% (167 to 79; P < .001) and the number of pneumococcal CAP cases decreased by 63% (64 to 24; P = .002). The number of additional PCV13 serotypes identified decreased by 74% (27 to 7). CONCLUSIONS Our data suggest a strong impact of PCV13 on CAP, pleural effusion, and documented pneumococcal pneumonia, particularly cases due to PCV13 serotypes.

Incidence of IgA vasculitis in children estimated by four-source capture–recapture analysis: a population-based study

Objectives The aim was to describe the epidemiological characteristics of childhood IgA vasculitis (IgAV) defined by the EULAR/PRINTO/Paediatric Rheumatology European Society criteria in a population-based sample from France and ascertain its incidence over 3 years by a four-source capture-recapture analysis. Methods Cases were prospectively collected in Val de Marne county, a suburb of Paris, with 263 874 residents <15 years old. Children with incident IgAV living in this area from 2012 to 2014 were identified by four sources of case notification (emergency departments, paediatrics departments, private-practice paediatricians and general practitioners). Annual incidence was calculated, and a capture-recapture analysis was used with log-linear modelling to estimate case-finding completeness. Results We identified 147 incident cases [78 boys; mean age 6.5 (s.d.:2.6) years]. The annual incidence (95% CI) was 18.6 (13.6, 24.5)/100 000 children. Although only 10% of children were exclusively identified by non-hospital sources, the completeness of case finding was 62%, with an undercount-corrected annual incidence (95% CI) of 29.9 (23.7, 37.3)/100 000 children. The annual distribution of diagnoses consistently showed a trough in summer months; 72% of children had infectious symptoms (mainly upper respiratory tract) a few days before IgAV onset; and 23% had a North African background. Conclusion Our study supports secular and geospatial stability in childhood IgAV incidence and adds further indirect evidence for a possible role of a ubiquitous, non-emerging infectious trigger. Incidence studies from understudied areas are needed to disentangle the role of genetic factors better. Capture-recapture analysis suggests that a substantial portion of IgAV cases may remain unrecognized in epidemiological surveys.

Impact of PCV13 on community-acquired pneumonia by C-reactive protein and procalcitonin levels in children

BACKGROUND Many countries have observed an early and strong impact of implementation of the 13-valent pneumococcal conjugate vaccine (PCV13) on community-acquired pneumonia (CAP). High levels of C-reactive protein (CRP) and procalcitonin (PCT) are considered biomarkers of bacterial infection (particularly infection due to pneumococcus); therefore, PCV13 implementation should have different effectiveness on CAP depending on the levels of these two biomarkers. To demonstrate this assumption, we analyzed the evolution of number of CAP cases seen in pediatric emergency departments in France after PCV13 implementation (in 2010) by levels of these two biomarkers. METHODS From June 2009 to May 2015, 8 pediatric emergency units prospectively enrolled all children (1month to 15years) with radiologically confirmed CAP. RESULTS A cohort of 9586 children with CAP was enrolled (median age 3years). CAP with pleural effusion (PE-CAP) and proven pneumococcal pneumonia (PP-CAP) accounted for 5.5% and 2.0% of cases. During the study period, the number of cases of overall CAP decreased by 25.4%, hospitalized CAP by 30.5%, PE-CAP by 63.4%, CAP with CRP level≥100mg/L by 50.9%, CAP with PCT level≥4ng/L by 60.4% and PP-CAP by 86.4%. We found no change in number of cases of CAP with low levels of CRP (<20 or <40mg/L) or PCT (<0.5ng/mL). The number of cases of CAP overall increased (20.0%) in the last year of the study as compared with the preceeding year but not cases with CRP level≥100mg/L and/or PCT level≥4ng/mL. CONCLUSION PCV13 implementation has had a strong impact on number of CAP cases with high levels of CRP and/or PCT in children but no impact on that with low levels of these two biomarkers. Five years after PCV13 implementation, a sustained reduction in CAP cases is observed.

Febrile urinary-tract infection due to extended-spectrum beta-lactamase–producing Enterobacteriaceae in children: A French prospective multicenter study

Objectives To assess the management of febrile urinary-tract infection (FUTIs) due to extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBL-E) in children, the Pediatric Infectious Diseases Group of the French Pediatric Society set up an active surveillance network in pediatric centers across France in 2014. Materials and methods We prospectively analysed data from 2014 to 2016 for all children < 18 years old who received antibiotic treatment for FUTI due to ESBL-E in 24 pediatric centers. Baseline demographic, clinical features, microbiological data and antimicrobials prescribed were collected. Results 301 children were enrolled in this study. The median age was 1 year (IQR 0.02–17.9) and 44.5% were male. These infections occurred in children with history of UTIs (27.3%) and urinary malformations (32.6%). Recent antibiotic use was the main associated factor for FUTIs due to ESBL-E, followed by a previous hospitalization and travel history. Before drug susceptibility testing (DST), third-generation cephalosporins (3GC) PO/IV were the most-prescribed antibiotics (75.5%). Only 13% and 24% of children received amikacine alone for empirical or definitive therapy, respectively, whereas 88.7% of children had isolates susceptible to amikacin. In all, 23.2% of children received carbapenems in empirical and/or definitive therapy. Cotrimoxazole (24.5%), ciprofloxacin (15.6%) and non-orthodox clavulanate–cefixime combination (31.3%) were the most frequently prescribed oral options after obtaining the DST. The time to apyrexia and length of hospital stay did not differ with or without effective empirical therapy. Conclusions We believe that amikacin should increasingly take on a key role in the choice of definitive therapy of FUTI due to ESBL-E in children by avoiding the use of carbapenems.

Aminoglycosides Monotherapy as First-Line Treatment for Febrile Urinary-Tract Infection in Children.

We report a retrospective monocentric descriptive study performed in CHI Creteil for 20 months to describe the management and outcome of amikacin monotherapy as an alternative to third-generation cephalosporins for empiric treatment of febrile urinary tract infection (FUTI) in children. Data were analyzed for 151 children, and 90 selected cases were classified as certain or highly probable FUTI. Escherichia coli infection was found in 89 cases. In all patients, fever was resolved within 72 hours after beginning amikacin treatment. Only 5.3% of children were febrile after 48 hours. The mean amikacin treatment duration was 3.05 ± 0.13 days before oral treatment began (guided by antibiotic susceptibility testing). Amikacin monotherapy seems effective for the initial management of FUTI in children.

When should clinicians suspect group A streptococcus empyema in children? A multicentre case–control study in French tertiary care centres

Background The incidence of invasive group A streptococcus (GAS) infections is increasing worldwide, whereas there has been a dramatic decrease in pneumococcal invasive diseases. Few data describing GAS pleural empyema in children are available. Objective To describe the clinical and microbiological features, management and outcome of GAS pleural empyema in children and compare them with those of pneumococcal empyema. Design, setting and patients Fifty children admitted for GAS pleural empyema between January 2006 and May 2013 to 8 hospitals participating in a national pneumonia survey were included in a descriptive study and matched by age and centre with 50 children with pneumococcal empyema. Results The median age of the children with GAS pleural empyema was 2 (range 0.1–7.6) years. Eighteen children (36%) had at least one risk factor for invasive GAS infection (corticosteroid use and/or current varicella). On admission, 37 patients (74%) had signs of circulatory failure, and 31 (62%) had a rash. GAS was isolated from 49/50 pleural fluid samples and from one blood culture. The commonest GAS genotype was emm1 (n=17/22). Two children died (4%). Children with GAS empyema presented more frequently with a rash (p<0.01), signs of circulatory failure (p=0.01) and respiratory disorders (p=0.02) and with low leucocyte levels (p=0.04) than children with pneumococcal empyema. Intensive care unit admissions (p<0.01), drainage procedures (p=0.04) and short-term complications (p=0.01) were also more frequent in patients with GAS empyema. Conclusions Pleural empyema following varicella or presenting with rash, signs of circulatory failure and leucopenia may be due to GAS. These features should prompt the addition to treatment of an antitoxin drug, such as clindamycin.

SFP PC-78 – Performances de la bandelette urinaire chez le jeune nourrisson

Objectif determiner les proprietes de la bandelette urinaire (BU) chez l’enfant ≤3 mois Methodes les donnees etaient issues d’une etude prospective multicentrique incluant des nourrissons febriles âges de 7 a 92 jours, admis aux urgences pediatriques. Une infection urinaire (IU) etait definie par la presence d’un seul germe pathogene ≥5.10 4 /mL (sondage) ou ≥1.10 5 /mL (poche). La BU etait consideree positive en cas de presence de traces ou plus pour l‘esterase leucocytaire (LE) et/ou pour les nitrites (NI). Les caracteristiques de la BU etaient decrites et compares entre les sexes Resultats une BU et une culture urinaire etaient realisees chez 722 enfants et obtenues dans 89% des cas par poche. La sensibilite (Se) et la specificite (Sp) d’un test positif pour les LE et/ou NI etaient de 84% et 89% respectivement. La Se n’etait pas differente entre les sexes (78% chez la fille vs 86% chez le garcon), la Sp etait plus elevee chez le garcon (95% vs 81% chez la fille, p Conclusion les caracteristiques de la BU chez le nourrisson ≤ 3 mois sont similaires a celles obtenues chez l’enfant plus âge.

SFP PC-77 – Prise en charge du nourrisson fébrile aux urgences pédiatriques

Objectif decrire les modalites de prise en charge du nourrisson febrile ≤3 mois et les comparer aux recommandations. Methodes une etude prospective multicentrique incluant des nourrissons ≤3 mois febriles sans point d’appel s’est deroulee dans 15 centres d’urgences pediatriques. La frequence des examens complementaires realises, des antibiotiques prescrits et des hospitalisations etait comparee entre les centres. Les variations par rapport aux recommandations etaient decrites selon differents scenarii et comparees entre les centres. Resultats Parmi les 2204 enfants inclus, les frequences d’examens realises : hemoculture (62%), culture urinaire (68%), ponction lombaire (64%), recherche virale naso-pharyngee (33%) et radiographie de thorax (67%), de prescription d’antibiotiques (42%), et d’hospitalisations (74%) etaient toutes significativement differents entre les centres, meme apres ajustement sur l’âge, l’apparence clinique et la duree de la fievre. Le taux d’adequation aux recommandations etait evalue entre 60 et 80% selon les scenarii de prise en charge, et variait significativement entre les centres. Conclusion la prise en charge du nourrisson febrile ≤ 3 mois varie entre differents centres et par rapport aux recommandations.

SFP PC-49 - Epidémiologie de la vascularite à IgA de l’enfant : enquête en population

Le purpura rhumatoide renomme vascularite a IgA(IgAV) est la vascularite la plus frequente de l’enfant. Son etiologie mal connue implique des facteurs genetiques et environnementaux. Des etudes en population sont necessaires pour rechercher des modifications de son epidemiologie. Objectifs Decrire les caracteristiques epidemiologiques de l’IgAV dans une large population francaise. Methodes Recueil prospectif de cas incidents d’IgAV d’enfants vivant dans le Val de Marne(258255enfants Resultats 80 cas ont ete inclus (H/F=1,2) d’âge moyen 7 ans[3–15]. L’incidence de 15.5/10 5 enfants/an (IC 95%13–24) est plus elevee en automne/hiver qu’au printemps/ete(p=0,02). Les manifestations etaient purpura(100%), urticaire(15%), arthralgies/arthrites(94%),œdeme des extremites(66%), atteinte digestive(54%), orchite(10%), atteinte renale(16%). L’atteinte renale etait en general moderee, seuls 2 enfants ont eu une biopsie renale. Conclusion L’incidence annuelle, le sexe ratio, les variations saisonnieres concordent avec les donnees rapportees par d’autres pays. La faible proportion d’atteinte renale et l’evolution favorable soulignent le profil plutot benin de la maladie a l’echelle de la population.