Les infections oto-rhino-laryngologiques (ORL) sont les plus fréquentes des infections de l’enfant et les premières causes de prescriptions d’antibiotiques. Dans l’immense majorité des cas, ces infections sont dues à des virus et même quand elles sont d’origine bactérienne, elles guérissent spontanément le plus souvent : le premier message à retenir est l’abstention de prescription d’antibiotique dans de très nombreuses situations d’infections des voies aériennes supérieures : rhinopharyngites, angines érythémateuses ou érythémato-pultacées non streptococciques, laryngites, otites congestives, otites séreuses. La décision de traitement antibiotique des angines repose essentiellement sur la positivité des tests de diagnostic rapide du streptocoque du groupe A (SGA). Concernant les otites, seules les otites moyennes aiguës purulentes (OMAP) survenant chez les enfants de moins de 2 ans et les formes d’OMAP compliquées ou les plus symptomatiques chez les enfants plus grands doivent être traitées par antibiotiques. L’amoxicilline est le traitement de première intention dans l’immense majorité des cas. Les infections ORL graves (mastoïdites, épiglottites, abcès rétro- et para-pharyngés, ethmoïdites) sont des urgences thérapeutiques justifiant une hospitalisation et une antibiothérapie intraveineuse initiale.

Les gastro-entérites sont le plus souvent d’origine virale, rotavirus et norovirus étant les virus les plus fréquemment en cause chez les jeunes enfants. Les PCR multiplex effectuées à partir des selles permettent de détecter des bactéries, des virus ou des parasites responsables ou non de la gastro-entérite. Si le profil étiologique de ces infections digestives a grandement bénéficié de la PCR, la présence de pathogènes potentiels ne justifie pas de traitement anti-infectieux en dehors de pathologies sous-jacentes. En effet, parmi les causes bactériennes, très peu nécessitent un traitement antibiotique en dehors des shigelloses, des formes graves de salmonellose et une partie des infections à Campylobacter sp. L’évolution de la résistance aux antibiotiques des salmonelles, shigelles et campylobacter est préoccupante dans le monde, limitant les options thérapeutiques. Les antibiotiques proposés dans ce guide sont en accord avec les recommandations communes de l’European Society of Pediatric Infectious Diseases et l’European Society of Pediatric Gastroenterology and Nutrition. L’azithromycine est préférentiellement utilisée pour traiter les infections à Shigella sp. ou à Campylobacter sp. La ceftriaxone et la ciprofloxacine sont recommandées pour traiter les salmonelloses nécessitant une antibiothérapie. Les traitements empiriques, sans identification bactérienne, ne sont pas indiqués en dehors d’un sepsis sévère ou chez des sujets à risque (drépanocytose par exemple). La prescription de métronidazole pour une amibiase intestinale aiguë ne doit être faite qu’après confirmation microbiologique.

Ear, nose and throat (ENT) or upper respiratory tract infections (URTI) are the most common infections in children and the leading causes of antibiotic prescriptions. In most cases, these infections are due to (or are triggered by) viruses and even when bacterial species are implicated, recovery is usually spontaneous. The first imperative is to refrain from prescribing antibiotics in a large number of URTIs: common cold, most cases of sore throat, laryngitis, congestive otitis, and otitis media with effusion. On the contrary, a decision to treat sore throats with antibiotics is based primarily on the positivity of the Group A Streptococcus (GAS) rapid antigen diagnostic tests. For ear infections, only (a) purulent acute otitis media in children under 2 years of age and (b) complicated or symptomatic forms of purulent acute otitis media (PAOM) in older children should be treated with antibiotics. Amoxicillin is the first-line treatment in the most cases of ambulatory ENT justifying antibiotics. Severe ENT infections (mastoiditis, epiglottitis, retro- and parapharyngeal abscesses, ethmoiditis) are therapeutic emergencies necessitating hospitalization and initial intravenous antibiotic therapy.

The topic of hydration of children over 3 years of age is often neglected in general pediatric consultations, even though proper hydration is essential for optimal physical and intellectual functions. Objective: To evaluate the daily water and beverage consumption of 3- to 8-year-old patients in a private pediatric practice through a retrospective observational study. Method: This single-centre study was conducted in a French private practice with five pediatricians and included 200 healthy children, aged 3-8 years. Results: Recommended intake of beverages was reached in 62% of 54 children in the 3- to 4-year-old group and 43% of the 146 children in the 4- to 8-year-old group. Recommended beverages intake of +/- 20% was found in 55% of the 3- to 4-year-old group and 45% of the 4- to 8-year-old group. The potential risk factors of inadequate hydration could not be demonstrated in this study. Water alone was the predominant intake in 63% of the 200 children; milk accounted for 19%, and sweetened drinks for 17%. Conclusions: These results show a persistent gap between recommended and observed total beverage intake. Although our results are more robust than previous French and international published data, they remain insufficient. In the future, a systematic approach to hydration with parents and children is needed including personalised advice, while maintaining other public health interventions in schools and canteens. (C) 2021 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.

Kingella kingae is the leading pathogen of osteoarticular infection in children under 4 years in different countries [[1]Yagupsky P. Kingella kingae: carriage, transmission, and disease.Clin Microbiol Rev. 2015; 28: 54-79Crossref PubMed Scopus (127) Google Scholar]. However, only a few studies have described the healthy carriage of K. kingae. In Israel and Switzerland, the highest colonization rate was around 10% in the children aged 12–24 months [1Yagupsky P. Kingella kingae: carriage, transmission, and disease.Clin Microbiol Rev. 2015; 28: 54-79Crossref PubMed Scopus (127) Google Scholar, 2Anderson de la Llana R. Dubois-Ferriere V. Maggio A. Cherkaoui A. Manzano S. Renzi G. et al.Oropharyngeal Kingella kingae carriage in children: characteristics and correlation with osteoarticular infections.Pediatr Res. 2015; 78: 574-579Crossref PubMed Scopus (18) Google Scholar]. To our knowledge, no epidemiological data on the healthy carriage is available in France. We aimed to determine the rate of and the factors associated with healthy carriage of K. kingae in young children in France, as well as the capsular serotype of these strains, known to be associated either with invasive or carriage strains [[3]Porsch E.A. Starr K.F. Yagupsky P. St Geme 3rd, J.W. The Type a and Type b polysaccharide capsules predominate in an International Collection of Invasive Kingella kingae isolates.mSphere. 2017; 2 (pii:e00060-17)Crossref PubMed Scopus (17) Google Scholar]. Between May 2015 and June 2016, 217 healthy children aged from 6 to 36 months were prospectively enrolled. Throat samples were collected, as previously described [[4]Basmaci R. Ilharreborde B. Bidet P. Doit C. Lorrot M. Mazda K. et al.Isolation of Kingella kingae in the oropharynx during K. kingae arthritis in children.Clin Microbiol Infect. 2012; 18: E134-E136Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar], by nine paediatricians from five different French departments (from Parisian Region: Paris, Seine-et-Marne, Seine-Saint-Denis, Val-De-Marne; and from Meurthe-et-Moselle, located in the Grand Est region), after recording the written consent of at least one of their parents. Children who had received antibiotics during the last 7 days were not eligible for inclusion. The protocol was approved by the Saint-Germain-en-Laye Ethics Committee (Comité de Protection des Personnes Ile-de-France XI). Continuous variables were compared by Mann–Whitney U-test. Categorical variables were compared by Fisher exact test or chi-squared test. All analyses were performed with R statistical package 3.3.2 (R Foundation for Statistical Computing, Vienna, Austria). A p value < 0.05 was considered statistically significant. Demographic and clinical features of the children included in the study are described in Table S2. In all, 171 children (78.8%) were included by two paediatricians ('two-paediatrician group') and 46 (21.2%) by the seven others ('seven-paediatrician group'). In the seven-paediatrician group, children were more frequently cared for out-of-home than in the two-paediatrician group (p < 0.001) (Table S2). To reliably define a K. kingae carriage, we first identified the positive rtxA samples, and then we needed a negative groEL PCR (highly specific of Kingella negevensis) [[5]El Houmami N. Bzdrenga J. Durand G.A. Minodier P. Seligmann H. Prudent E. et al.Molecular tests that target the RTX locus do not distinguish between Kingella kingae and the recently described Kingella negevensis species.J Clin Microbiol. 2017; 55: 3113-3122Crossref PubMed Scopus (23) Google Scholar], to discriminate K. kingae (rtxA+/groEL–) from K. negevensis (rtxA+/groEL+). No rtxA+/groEL + samples were found, which excluded the possibility of a mixed colonization. To consolidate the identification of K. kingae, we also performed cpn60 real-time PCR [[6]Ilharreborde B. Bidet P. Lorrot M. Even J. Mariani-Kurkdjian P. Liguori S. et al.New Real-Time PCR-Based Method for Kingella kingae DNA Detection: Application to Samples Collected from 89 Children with Acute Arthritis.J Clin Microbiol. 2009; 47: 1837-1841Crossref PubMed Scopus (154) Google Scholar]. All the rtxA-positive samples were cpn60-positive, but some rtxA-negative samples were cpn60-positive. To explore this discrepancy we attempted to sequence the cpn60 allele [[7]Basmaci R. Yagupsky P. Ilharreborde B. Guyot K. Porat N. Chomton M. et al.Multilocus sequence typing and rtxA toxin gene sequencing analysis of Kingella kingae isolates demonstrates genetic diversity and international clones.PLoS One. 2012; 7e38078Crossref PubMed Scopus (35) Google Scholar]. When the sequences could be confidently read, we observed that the rtxA-positive samples exhibited a known K. kingae cpn60 allele, whereas the rtxA-negative samples exhibited an allele closely related to a different species (Simonsiella muelleri). Kingella kingae was detected by PCR in 11 (5.1%; 95% CI 2.6%–8.9%) out of the 217 children. No K. kingae strain could be isolated by culture on a selective medium, as previously described [[4]Basmaci R. Ilharreborde B. Bidet P. Doit C. Lorrot M. Mazda K. et al.Isolation of Kingella kingae in the oropharynx during K. kingae arthritis in children.Clin Microbiol Infect. 2012; 18: E134-E136Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar]. The peak of prevalence of healthy carriage appeared in children aged 18–23 months (11.4%; 95% CI 3.2%–26.7%) (see Supplementary material, Fig. S1). For capsular typing, we performed a multiplex PCR allowing four types to be distinguished: 'a', 'b', 'c' and 'd', using a modified protocol (see Supplementary material, Table S1). To identify the capsule type based on molecular weight after gel electrophoresis, we used eight K. kingae strains with known capsule type as positive controls (two per capsule type) (see Supplementary material, Fig. S2a). Among the 11 K. kingae-positive throat samples, the capsule type was successfully determined in nine cases (see Supplementary material, Fig. S2b). Capsules a and b were identified in four samples each, and simultaneous capsules a and c were identified in one sample, and no amplification product was visualized for the two remaining samples. Whether a lack of PCR sensitivity was observed in an oropharyngeal sample or capsules other than those already known could be elaborated by the species remains to be determined. Demographic and clinical characteristics of the 11 K. kingae healthy carriers, compared with their 206 non-carrier counterparts, are described in Table S2. Healthy carriers were more frequently cared for out-of-home than non-carriers (63.6% versus 21.4%, respectively; p 0.004), especially in day-care centre (63.6% versus 17.0%, respectively; p 0.002). Hence, the prevalence of carriage was higher in children cared for out-of-home than in children cared for at home (13.7% versus 2.4%, respectively; p 0.004). Of interest, although not significant, six out of seven (85.7%) carriers who were cared for out-of-home attended at least 4 days per week (Table S2), leading to a prevalence of carriage of 15.8% (6/38; 95% CI 6.0%–31.3%) among children attending a day-care centre at least 4 days per week. Those results appeared similar to those previously described in other countries [2Anderson de la Llana R. Dubois-Ferriere V. Maggio A. Cherkaoui A. Manzano S. Renzi G. et al.Oropharyngeal Kingella kingae carriage in children: characteristics and correlation with osteoarticular infections.Pediatr Res. 2015; 78: 574-579Crossref PubMed Scopus (18) Google Scholar, 8Amit U. Dagan R. Yagupsky P. Prevalence of pharyngeal carriage of Kingella kingae in young children and risk factors for colonization.Pediatr Infect Dis J. 2013; 32: 191-193Crossref PubMed Scopus (29) Google Scholar]. Although not significant, we observed a higher carriage rate during spring (8/117; 6.8%) and autumn (2/32; 6.3%) than during winter (1/68; 1.5%) (p 0.23). A high sensitivity of the oropharyngeal culture method has been observed in children with K. kingae septic arthritis [[4]Basmaci R. Ilharreborde B. Bidet P. Doit C. Lorrot M. Mazda K. et al.Isolation of Kingella kingae in the oropharynx during K. kingae arthritis in children.Clin Microbiol Infect. 2012; 18: E134-E136Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar], but no K. kingae strain could be isolated from the oropharynx of the healthy children in the current study. Although Ceroni et al. [[9]Ceroni D. Llana R.A. Kherad O. Dubois-Ferriere V. Lascombes P. Renzi G. et al.Comparing the oropharyngeal colonization density of Kingella kingae between asymptomatic carriers and children with invasive osteoarticular infections.Pediatr Infect Dis J. 2013; 32: 212-214Crossref Scopus (18) Google Scholar] have demonstrated that the colonization density of K. kingae, based on real-time rtxA PCR results, among healthy paediatric carriers is not inferior to that observed in children with skeletal system infections, the lack of specificity of this PCR cannot rule out that ill children present a higher bacterial load than asymptomatic children. Several limitations could be identified in our study. First, the low number of carriers identified may lead to a decrease in the representativeness of our results. Second, the rate of children who were cared for out-of-home in the two-paediatrician group (78.8% of the study population) was lower than that in the seven-paediatrician group, the latter being close to that observed in France [[10]Angoulvant F. Cohen R. Doit C. Elbez A. Werner A. Bechet S. et al.Trends in antibiotic resistance of Streptococcus pneumoniae and Haemophilus influenzae isolated from nasopharyngeal flora in children with acute otitis media in France before and after 13 valent pneumococcal conjugate vaccine introduction.BMC Infect Dis. 2015; 15: 236Crossref PubMed Scopus (37) Google Scholar] (17.0%, 47.8% and 45%, respectively). This may have led to an underestimate of the carriage rate in our study. The first study on the K. kingae healthy carriage in France revealed a similar carriage rate compared with other countries; and day-care centre attendance appeared as an important associated factor. Capsule types a and b, associated with invasive infection, were commonly observed in our healthy population. Further studies are required to describe the genotypes and the antibiotic susceptibility patterns of the K. kingae carriage strains. C. Levy reports grants, personal fees and non-financial support from Pfizer, and grants from GSK, Sanofi and Merck, outside the submitted work; S. Béchet reports grants from Pfizer, GSK, Sanofi and Merck, outside the submitted work; and R. Cohen reports grants, personal fees and non-financial support from Pfizer, and grants and personal fees from GSK, Merck and Sanofi, outside the submitted work. The other authors have nothing to disclose. This work was supported by the Association Clinique et Thérapeutique Infantile du Val de Marne. The funder played no role in the study design; in the collection, analysis and interpretation of the data; in the writing of the report; and in the decision to submit the paper for publication.

Le but de ce travail était d’évaluer les performances des tests de diagnostic rapide (TDR) du streptocoque du groupe A (SGA) dans les infections extra-pharyngées. Entre octobre 2009 et juin 2014, 368 patients (âge médian : 48 mois) ont été inclus. Les enfants présentaient les pathologies suivantes : 160 infections périnéales (44 %), 69 tournioles (19 %), 55 adénites cervicales (15 %), 31 rhinites croûteuses ou hémorragiques (8 %), 53 autres pathologies (14 %). La sensibilité du TDR du SGA utilisé était de 96 % (IC 95 % : 92–99 %), la spécificité de 81 % (IC 95 % : 75- 86 %), la valeur prédictive négative de 97 % (IC 95 % : 93–99 %), la valeur prédictive positive de 79 % (IC 95 % : 73–85 %). Enfin, les rapports de vraisemblance positif et négatif étaient respectivement de 5 (IC 95 % : 4–7) et de 0,05 (IC 95 % : 0,02–0,11). Les TDR du SGA mis au point pour l’angine ont des performances comparables dans ces différentes pathologies et de ce fait peuvent être utilisés.

Réaliser une validation externe des règles de décision clinique (RDC) pour le diagnostic des angines à streptocoque du groupe A (SGA). Les 8 RDC identifiées grâce à une revue systématique ont été appliquées aux données d'une cohorte prospective de 676 enfants avec angine de la manière suivante : faible risque de SGA d'après la RDC, pas de test de diagnostic rapide (TDR) ni d'antibiotique ; risque intermédiaire, antibiothérapie selon le résultat d'un TDR ; haut risque, antibiothérapie empirique. Le test de référence était la culture de prélèvement de gorge. Les données manquantes ont été gérées par imputation multiple. La calibration des RDC était faible et aucune RDC n'était capable de rejeter ou de confirmer le diagnostic de SGA (risque de SGA<12% ou ≥85%) sur la base de critères cliniques. La sensibilité, la spécificité, le C-index et le nombre de TDR utilisés variait de 66% à 94%, 40% à 88%, 0,64 à 0,87 et 24% à 86%, respectivement. Le C-index était fortement corrélé au nombre de TDR utilisés (rho=0,94 ; p<0.01). Les RDC disponibles pour sélectionner les enfants chez qui réaliser un TDR ne sont pas suffisamment bien calibrées ni performantes pour pouvoir être recommandées en pratique clinique.

The purpose of this study was to assess the performances of the group A streptococcus (GAS) rapid antigen diagnostic tests (RADTs) in extra-pharyngeal infections. Between October 2009 and June 2014, 368 patients (median age: 48 months) were enrolled. The pathologies involved were : 160 perineal infections (44 %), 69 blistering distal dactylitis (19 %), 55 cervical lymphadenitis (15 %), 31 crusty or bleeding rhinitis (8 %), and 53 other diseases (14 %). The sensitivity of GAS-RADT used was 96 % (95 % CI: 92-99 %), the specificity 81 % (95 % CI: 75- 86 %), the negative predictive value 97 % (CI 95 %: 93-99 %), and the positive predictive value 79 % (95 % CI: 73-85 %). Finally, positive and negative likelihood ratio were 5 (95 % CI: 4-7) and 0.05 (95 % CI: 0.02-0.11) respectively. The GAS-RADTs developed for pharyngitis have comparable performances in these settings and therefore can be used.

Evaluer en France, la résistance aux antibiotiques des pneumocoques isolés dans la flore rhinopharyngée, chez des enfants ayant une otite moyenne aiguë (OMA) avant et après l'introduction du vaccin pneumococcique conjugué 13 valent (PCV13). De 2006 à 2012, 66 pédiatres ont réalisé des prélèvements rhino-pharyngés chez des enfants de 6 à 24 mois présentant une OMA. Deux périodes ont été définies ; avant et après juin 2010 : soit pré-PCV13 et post-PCV13. Parmi les 6280 enfants inclus (âge médian : 13 mois), plus de 99% étaient vaccinés par un PCV dont 2483 (40%) par PCV13 en période post-PCV13. Le portage du pneumocoque était de 57%. Entre les 2 périodes, les souches de pneumocoques de sensibilité diminuée à la pénicilline (PSDP) ont diminué de 46% à 39% (p <0,0001). Les souches appartenant aux 6 sérotypes additionnels du PCV13 étaient des PSDP dans 68% des cas (584/859) ; leur taux est passé de 19% (n=648) en pré-PCV13 à 8% (n=211) en post-PCV13 (p <0,0001). Nos données suggèrent une réduction du portage des souches PSDP dans la période post-PCV13 chez des enfants atteints d'OMA. Cette réduction semble principalement liée à la diminution des souches appartenant aux 6 sérotypes additionnels du PCV13.

Community-acquired pneumonia (CAP) is a frequent event in patients with COPD, although it is not currently considered an acute exacerbation of COPD (AECOPD). To our knowledge, no studies have compared the inflammatory response of patients with COPD who develop CAP or AECOPD. The aim of our study was to compare clinical and evolutive manifestations and biologic signaling of AECOPD and CAP + COPD.Prospective data were collected from 249 consecutively hospitalized patients with COPD. Comparative analyses were performed in patients with AECOPD (n = 133) and patients with CAP + COPD (n = 116). Measures of clinical characteristics, blood biomarkers, and evolution were recorded on admission, after 3 and 30 days, and in a follow-up period of 30 days, 90 days, and 1 year.Patients with CAP + COPD had higher FEV1 compared with patients with COPD without pneumonia. In-hospital and long-term outcomes (1 year) were similar for both populations. However, patients with AECOPD had more readmissions, and patients with CAP had more prior episodes of pneumonia. At day 1 and day 3, patients with CAP + COPD had significantly (P < .001) higher serum levels of C-reactive protein (CRP), procalcitonin, tumor necrosis factor-α, and IL-6. Repetition of the analyses after stratifying patients based on severity of disease, current inhaled pharmacotherapy, and noninfectious AECOPD cause confirmed higher levels of the same biomarkers in patients with CAP + COPD. Chills, pleuritic pain, sputum purulence, and CRP levels at day 1 were independent clinical predictors of CAP + COPD.Our study confirms that two different clinical and inflammatory profiles exist in hospitalized patients with COPD in response to CAP (stronger response) and AECOPD, although with similar short-term and long-term outcomes.

Les parasitoses cutanées sont fréquentes en pathologie humaine. Elles sont cosmopolites mais leur distribution mondiale est irrégulière. Les données épidémiologiques fiables sur la prévalence et/ou l'incidence de ces parasitoses sont rares mais la prévalence est surtout élevée dans les pays subtropicaux et tropicaux. Les parasitoses cutanées sont principalement dues aux arthropodes (acariens et insectes) qui parasitent le tégument ou les phanères. De nombreuses espèces de parasites sont en cause, expliquant la grande diversité de leurs manifestations cutanées. Les plus fréquentes sont dues aux ectoparasites comme la gale ou les pédiculoses (du cuir chevelu, corporelle ou pubienne). Les signes cliniques peuvent être liés à la pénétration du parasite sous la peau, à son développement, aux venins inoculés ou aux manifestations allergiques qu'il entraîne. Le diagnostic peut être aisé en cas de signes cliniques pathognomoniques (i.e. sillons des espaces interdigitaux pour la gale) ou parfois plus difficile. Certaines caractéristiques épidémiologiques (piqûre diurne ou nocturne, saisonnalité) ou sémiologiques (piqûres uniques ou multiples, linéaires ou en bouquet) peuvent être d'une aide précieuse. La place des outils d'imagerie non invasive moderne (dermoscopie ou microscopie confocale in vivo) sera à déterminer à l'avenir mais l'œil et l'expérience du spécialiste (dermatologue, infectiologue, parasitologue, entomologiste) reste pour l'instant indispensable pour orienter ou établir un diagnostic de certitude. Pour la plupart des parasitoses cutanées, les propositions thérapeutiques reposent rarement sur des études de fort niveau de preuve ou d'essais randomisés mais plutôt sur des recommandations d'expert ou sur l'expérience personnelle.Cutaneous parasitic skin diseases are frequent in human pathology. There are few reliable epidemiological data on the prevalence and/or incidence of such diseases. Skin parasites are cosmopolitan but their global distribution is heterogenous; prevalence is especially high in subtropical and tropical countries. They are mainly due to arthropods (insects and mites). Many species of parasites are involved, explaining the diversity of their clinical signs. The most common are caused by ectoparasites such as scabies or pediculosis (head lice, body lice and pubic lice). Clinical signs may be related to the penetration of the parasite under the skin, its development, the inoculation of venom or allergic symptoms. Diagnosis can be easy when clinical signs are pathognomonic (e.g. burrows in the interdigital web spaces in scabies) or sometimes more difficult. Some epidemiological characteristics (diurnal or nocturnal bite, seasonality) and specific clinical presentation (single or multiple bites, linear or grouped lesions) can be a great diagnostic help. Modern non-invasive tools (dermoscopy or confocal microscopy) will play an important role in the future but the eye and experience of the specialist (dermatologist, parasitologist, infectious disease specialist or entomologist) remains for the time the best way to guide or establish a diagnosis. For most skin parasites, therapeutic proposals are rarely based on studies of high level of evidence or randomized trials but more on expert recommendations or personal experience.

Reducing antibiotic consumption has now become a major public health priority. Reducing treatment duration is one of the means to achieve this objective. Guidelines on the therapeutic management of the most frequent infections recommend ranges of treatment duration in the ratio of one to two. The Recommendation Group of the French Infectious Diseases Society (SPILF) was asked to collect literature data to then recommend the shortest treatment durations possible for various infections.Analysis of the literature focused on guidelines published in French and English, supported by a systematic search on PubMed. Articles dating from one year before the guidelines publication to August 31, 2015 were searched on the website.The shortest treatment durations based on the relevant clinical data were suggested for upper and lower respiratory tract infections, central venous catheter-related and uncomplicated primary bacteremia, infective endocarditis, bacterial meningitis, intra-abdominal, urinary tract, upper reproductive tract, bone and joint, skin and soft tissue infections, and febrile neutropenia. Details of analyzed articles were shown in tables.This work stresses the need for new well-conducted studies evaluating treatment durations for some common infections. Following the above-mentioned work focusing on existing literature data, the Recommendation Group of the SPILF suggests specific study proposals.Réduire les durées des traitements antibiotiques est un des moyens permettant une réduction globale de la consommation d'antibiotiques. Les recommandations, même les plus récentes, proposent très souvent des fourchettes de durées de traitement. Le Groupe recommandations de la Société de pathologie infectieuse de langue française (SPILF) a effectué une revue de la littérature, dans le but de faire des propositions de durées de traitements courts dans les infections bactériennes.Revue de la littérature, jusqu'au 31 août 2015, des essais randomisés abordant les durées de traitement, des recommandations récentes et de leurs argumentaires.Des durées de traitement courtes (souvent plus courtes que dans certaines recommandations) peuvent être proposées pour les infections respiratoires hautes et basses, les bactériémies dont celles liées aux cathéters veineux centraux, les endocardites infectieuses, les méningites bactériennes, les infections intra-abdominales, urinaires et génitales, les infections ostéo-articulaires, les infections de la peau et des tissus mous et les neutropénies fébriles. Le détail des articles sur lesquels se basent ces propositions est repris dans des tableaux.Ce travail, qui montre la pauvreté de la littérature s'intéressant spécifiquement aux durées de traitements antibiotiques, permet d'identifier les études à réaliser de façon prioritaire dans ce domaine.

Objectives. - The choice of antibiotics (ATB) to treat acute otitis media (AOM) has to take into account the level of resistance of bacteria species implicated. The aim of this study was to evaluate in France, ATB resistance of pneumococci and H. influenzae isolated from the nasopharyngeal flora, in children with AOM, vaccinated with 7 valent pneumococcal conjugate vaccine (PCV7).Methods. - From 2006 to 2010, 66 pediatricians performed nasopharyngeal specimens of children 6 to 24 months with AOM. Demographic characteristics, history, vaccination status and symptoms were reported on a case report form transmitted to ACTIV.Results. - Of the 3501 children included (mean age 13.5 +/- 5 months), over 98% were PCV7 vaccinated and 41.1% were cared in day care center. A total of 47.3% of children had received ATB within 3 months before inclusion (cephalosporins, 22.6% and amoxicillin clavulanate, 19.2%). Pneumococcus and H. influenzae carriage was respectively 57.9% and 48.2%. Pneumococcal strains with reduced susceptibility to penicillin represented 46.3% of cases (3.9% highly resistant strains and 42.4% intermediate resistant strains). Factors that increased the risk of carrying these strains were: day care center (OR: 1.5, 95% CI: [1.2, 1.9]) and two courses or more of ATB before inclusion (OR: 2.6 (95% CI: [2.0, 3.4]). For H. influenzae strains the proportion of beta lactamases+ producing strains was 17.1% and those with reduced susceptibility due to penicillin binding protein changes (BLNAR+ strains+) accounted for 7.7% of cases. Three factors increased the risk of carriage BLNAR+ beta lactamases+ producing strains: age equal or greater than 12 months (OR: 3.5, 95% CI: [1.2, 10.3]), cephalosporin use (OR: 2.5, 95% CI: [1.0, 6.1]) and two courses or more of ATB before inclusion (OR: 3.1, 95% CI: [1.2, 8.0]).Conclusion. - The data in this study (reduction of beta lactamases producing H. influenzae strains and increase of intermediate penicillin pneumococcal strains) should help to change the choice of antibiotics for AOM in children in France, by reducing the role of oral cephalosporins and secondly, by giving frontline amoxicillin clavulanic acid. (C) 2011 Elsevier Masson SAS. All rights reserved.

Background. - In US, pneumococcal conjugate vaccine (PCV7) had reduced the burden of AOM and changed the profile of the disease. Prior to PCV7 implementation in France, AOM represented 8% of pediatricians visits and failure rate was 12%. The aim of this study is to describe the epidemiologic characteristics of AOM after PCV7 implementation.Methods. - From 2007 to 2008, 30 pediatricians enrolled 3141 patients 3 to 36 months old with AOM. Standardized history and physical examination findings were recorded. Factors related to AOM failures were identified by multivariate logistic regression.Results. - AOM accounted for 5.8% of the 43 433 visits or 6.2 cases/week per pediatrician. Among 3141 evaluable AOM cases (mean age 16.7 +/- 8 months, peak incidence at 10 months), 99% had been vaccinated with PCV7 and 42.1% attended day care (DCC). Recurrent AOM comprised 24.5% of cases and 51% of children had received ATB in the last 3 months. At the time of diagnosis, 47.1% had fever >= 38,5 degrees C, 74.5% otalgia and 4.7% otorrhea. Febrile and painful AOM accounted for 29.5% of cases and cunjunctivitis-otitis syndrome for I 8.2%. ATB was prescribed in 98.7% of cases (cefpodoxime proxetil, 59% and amoxicillin/clavulanate, 37%). The failure rate was 6.4% and failure risk was greater in children in DCC (OR = 1.50, [1.10;2.05]), young age < 18 months (OR = 1.47, [1.06;2.04]) and history of recurrent AOM (OR = 1.45, [1.02;2.06]).Conclusion. - Despite PCV7 implementation, AOM remains a very frequent childhood infection and a major reason for ATB prescriptions. (C) 2011 Elsevier Masson SAS. All rights reserved.

OBJECTIVE:Several studies have highlighted the assets of the influenza rapid diagnostic tests (IRDT) for the emergency department management of febrile children. The objective of this study was to determine in ambulatory pediatric setting impact of IRDT on the management of febrile children during an epidemic, especially on other diagnostic testing performed, antibiotic and antiviral treatments. METHODS:During an influenza epidemic, 37 paediatricians in three different areas of France included all children presenting fever with respiratory illnesses; they performed IRDT (test QuickVue for Influenza A and B, Quidel). Data collected were antiflu vaccination, previous asthma, symptoms, clinical signs, other diagnostic testing performed, and a follow-up two weeks later. RESULTS:Between December, 2006 and April, 2007, 695 children entered the program. The average age of those children was 4.1 years old (SD 3.4), median 3.2 (0.07-17.5). In 41.6% of the cases, the tests proved positive. Among 13 symptoms of influenza, only five were significantly more present in the group IRDT+: shiver (68.1% versus 57.4%), asthenia (87% versus 79.9%), cough (87.5% versus 70.1%), rhinorrhea (93.4% versus 83.3%), and sleepiness (54.2% versus 43.4%). The number of laboratory tests and radiographs ordered were less frequent in group IRDT+ than in group IRDT-: respectively 0.7% versus 11.6%, and 0.7% versus 8.6% (p<0.0001). IRDT+ group received antibiotics in 7.6% of cases (22 patients, 20 for OMA) and antiviral in 64.7%. IRDT- group received respectively 18.5% antibiotics, and no antiviral (p<0.0001). CONCLUSION:This study confirms the difficulty of clinical influenza diagnosis, and suggests the assets of IRDT to diagnose influenza and to improve the management of influenza in ambulatory paediatric setting.

Objectifs La fièvre isolée est un motif fréquent de consultation en pédiatrie. Plusieurs études ont montré l’intérêt d’un test rapide de la CRP (TDR-CRP) aux urgences hospitalières. Cette étude a pour objectif d’évaluer l’apport de ce test en pédiatrie ambulatoire. Matériels et Méthodes Une étude a été mise en place, en 2006-2007, dans des cabinets de pédiatrie répartis en 2 groupes : le groupe 1 disposait de TDR-CRP (NycoCard® CRP Single test, Progen Biotechnique), le groupe 2 adressait les enfants au laboratoire pour un dosage de CRP en macrométhode. Etaient inclus les enfants de plus de 3 mois consultant pour fièvre isolée, pour lesquels une CRP était prescrite. Résultats Deux cent vint-sept enfants ont été inclus par 17 pédiatres : 159 dans le groupe 1 et 68 dans le groupe 2. Dans le groupe 1, les examens sanguins (3,8 % versus 100 %, p < 0,0001) et les ECBU (19,5 % versus 67,6 %, p < 0,0001) étaient significativement moins prescrits dans le groupe 1 que dans le groupe 2, alors que les examens radiologiques ne l’étaient pas ; les bandelettes urinaires étaient plus souvent réalisées (22,6 versus 4,4, p : 0,0009). Le coût des examens biologiques demandés « en routine » était en moyenne réduit d’environ 80 % dans le groupe 1 : 7,7 euros versus 39,3 euros (p < 0,0001). Le délai moyen de récupération des résultats des examens prescrits en laboratoire était de 11 heures environ (médiane 4,5h) pour moins de 5 minutes pour avec TDR-CRP. À l’issue de la consultation, il n’y avait pas de différence de prescription d’antibiotiques entre les deux groupes. Par contre, dans le groupe 1, en cas de CRP supérieure ou égale à 60, la prise en charge était significativement différente : plus d’examens sanguins, de radiographies thoraciques, d’ECBU prescrits, d’antibiotiques prescrits. Dans le groupe 2, la prise en charge n’était pas différente en fonction des résultats de la CRP. Conclusions Cette étude montre l’intérêt du TDR-CRP dans la prise en charge des enfants fébriles en pédiatrie de ville : baisse du nombre et du coût des examens demandés en routine, obtention beaucoup plus rapide des résultats.

Objective.- Fever without source (FWS) is a common cause of children visits to pediatric practices. Clinical evaluation does not always rule out efficiently an invasive bacterial infection. Among blood markers, several publications have suggested the value of C-reactive protein (CRP). This study was performed to assess, in private practices, the impact of rapid CRP test compared to usual technique at the laboratory for the management of children with FWO.Material and methods.- The study was undertaken in 2006-2007, in 14 pediatric practices. Pediatricians had to enroll all children, older than three months, consulting for FWS, for whom CRP was prescribed. The pediatric practices were distributed in two groups: in the first one, pediatricians had rapid CRP tests (NycoCard (R) CRP test, Progen Biotechnique) and in the second one, they sent children to laboratory for the dosage of CRP as usually.Results.- Between October 2006 and June 2007, 227 children were enrolled by 17 pediatricians: 159 in the group with rapid CRP test (group 1), 68 in the group without (group 2). The cost of routine biological tests (micro or macro CRP, blood cell count and urine cultures) was on average lower for group 1 compared to the group 2: respectively 7.7 versus 39.3 (sic) (P < 0.0001), a reduction from. approximately 80% of cost. In group 1, more dipstick urine tests (22.6 versus 4. 4, P = 0.0009), less urine cultures (19.5% versus 67.6% P < 0.0001) and blood prescriptions were prescribed (3.8% versus 100%, P < 0.0001), pulmonary X-rays were not different (23.9% versus 19.1 %, P = 0.4). It was not observed difference in antibiotic prescription between the two groups (15.7% group 1 versus 19.1 % group 2, p = 0.5). The average time to obtain the results examinations in laboratory was approximately II h (median 4.5 h, extremes 45 min to two days), for five min in group 1. In group 1, children management was different according to the CRP levels. During the follow-up, no difference was observed between the two groups except less hospitalizations in group 1 (2.9% versus 15.3%, P = 0.00 15).Conclusion.- This study suggests the interest of rapid CRP test for febrile children in ambulatory pediatric practice by reducing number and cost of laboratory examinations and timesaving for patients and practitioners. (C) 2008 Elsevier Masson SAS. Tous droits reserves.