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D Gendrel

Publications and source records attributed to D Gendrel.

At least 19 recordsLinked to original sources
PubMed2002

[Hospitalization for acute community-acquired rotavirus gastroenteritis: a 4-year survey].

OBJECTIVE: To evaluate the number of hospitalizations due to community-acquired rotavirus acute gastroenteritis in a general pediatric unit during a four-year survey. RESULTS: From January 1997 to December 2000, 725 patients were admitted for acute gastro-enteritis to the general paediatric unit of a Parisian children hospital (nosocomial diarrhoea excluded) and 706 (97.5%) of these patients had had a stool microbiologic examination. Diarrhoea was caused by rotavirus in 359 patients (50.89%) and Salmonella sp in 61 (8.6%). Children and infants hospitalized for rotavirus acute gastroenteritis were younger (26% had three months or less, and 50.03% had six months or less) than in other European studies. CONCLUSION: This study is the first in France reporting a systematic survey of hospitalized gastroenteritis during four years. More than half of hospitalized community-acquired gastroenteritis were due to rotavirus in this Parisian area. The young age of patients should be investigated in other French areas, searching for risk factors and rotavirus strains.

Acute Disease↗
PubMed2002

[Community-acquired pneumonia in children: etiology and treatment].

Due to their very different etiological agents, community-acquired pneumoniae in children frequently require empiric antibiotic therapy in emergency. Streptococcus pneumoniae represents between 15 to 30% of the etiologies and has unspecific diagnostic procedures; as a matter of fact radiological lobar consolidation is seen in less than half of cases, and laboratory data, except for high procalcitonin level, are poorly reliable. Pneumonia due to Mycoplasma pneumoniae is frequent after 2 years of age, reaching 40 to 60% of causes in ambulatory teenagers; it must be treated with macrolides as sequellae are possible. The exact number of viral pneumonia is difficult to establish because of the lack of reliable diagnostic methods. If bacterial superinfections are probably overestimated during acute phase, viral infections may lead to bacterial pneumonia 2 to 4 weeks after the initial episode. Empiric antibiotic treatment must take into account pneumococci and their penicillin-resistant strains. Amoxicillin is the antibiotic of choice, having a higher efficacy on resistant pneumococci than oral cephalosporins. In case of clinical failure of amoxicillin, mycoplasma infection must be considered and patient must receive macrolides. Future epidemiology will be affected by anti-pneumococcal immunisation but difficulties in diagnosis and empiric antibiotic treatment will probably remain. Studies in immunised children are needed to evaluate the importance of pneumococcal infections due to serotypes not included in the vaccine.

Child↗
PubMed2002

[Procalcitonin and viral meningitis: reduction of unnecessary antibiotics by measurement during an outbreak].

OBJECTIVE: Viral meningitis are often treated with antibiotics in emergency because routine analysis of CSF is not always efficient for distinguishing between viral and bacterial infection. The aim of the study was to evaluate the usefulness of procalcitonin (PCT) to reduce antibiotic treatments. METHODS AND RESULTS: A blood PCT level < 0.5 ng/mL was prospectively used for the diagnosis of viral origin of meningitis in 58 patients (two months-14 years), in which enterovirus was isolated by culture or PCR during an outbreak (May-June 2000). CSF cells range was 10 to 2800/mL (m: 244), PMN 5 to 2464/mL and CSF proteins range was 0.19 to 0.92 mg/dL (m: 0.37). Seventeen patients received antibiotic therapy in admission. In nine patients, PCT (dosage was routinely measured 3/week) result < 0.5 ng/mL was obtained in 24 h and in 48 h in six: treatment was then stopped and children led hospital. In two patients, PCT was > 1 ng/mL because of bacterial coinfection. CSF and PCT values were similar to those of an already published control group. CONCLUSION: PCT dosage allowed to shorten hospitalization of 4.47 (controls) to 2.06 (patients) days in patients receiving unnecessary antibiotic treatments. During this outbreak, PCT dosage allowed to reduce 40 days of hospitalization.

Adolescent↗
PubMed2002

[Nosocomial bacteremias in pediatrics].

OBJECTIVES: To identify pathogenic microorganisms responsible for hospital-acquired bloodstream infections and to evaluate the associated risk factors in pediatric units, in a case-control study over 30 months from January 1st 1997 to June 30th 1999. RESULTS: Forty-six of 855 (5.4%) positive blood cultures were attributed to nosocomial infections. They were related to 32 infectious episodes in 28 patients hospitalized for more than 48 hours. The incidence rate was 0.11 per 100 admissions. Gram-positive cocci (n = 14; 38.8%) were the most frequently isolated pathogens (7 cases of Staphylococcus aureus, 5 of coagulase-negative staphylococci), followed by enterobacteria (n = 9; 25%), Pseudomonas aeruginosa (n = 5; 13.8%) and yeasts (n = 5; 13.8%). The major risk factors for hospital-acquired bloodstream infections were: length of stay before positive blood culture (32 +/- 51 days in cases vs 15 +/- 43 days in controls, p < 0.01), presence of central venous catheter [odds ratio (OR): 6.05, 95% confidence interval (CI): 1.87-20.42], number of days with central venous catheter (p < 0.001) and parenteral nutrition (OR: 9.44, 95% CI: 2.03-50.05). CONCLUSION: Central venous catheter use, length of stay, parenteral nutrition and particularly intravenous lipids are major risk factors for the acquisition of bloodstream infection in hospitalized children.

Age Factors↗
PubMed2002

[Fluoroquinolones in children].

The only currently recommended pediatric use of fluoroquinolones involves ciprofloxacine for treatment of pyocyanic infection in children with cystic fibrosis. The main contraindication for use of fluoroquinolones in children is arthrotoxicity. Notwithstanding they are occasionally used for serious infections when there is no other therapeutic alternative. In addition to cystic fibrosis, potential pediatric indications include multidrug-resistant salmonella and shigellosis, certain enterobacterial infections in newborns, complicated urinary tract infections, and severe multidrug-resistant bacterial infection especially in immunocompromised subjects. The availability of new quinolones against pneumococcus should have little impact on current therapeutic strategies for upper or lower respiratory tract infections since potential indications in children are limited. However when the new generation reaches the market, fluoroquinolones should offer new alternatives for treatment of penicillin-resistant pneumococcal meningitis. Studies comparing children and adults have shown that arthrotoxicity is approximately the same or only slightly higher. The main problem for assessment of adverse effects is that pediatricians often fail to report the limited number of cases in which fluoroquinoles have been prescribed. Regardless fluoroquinolones must remain a second or third line agent for treatment of severe infection in cases in which no other alternative especially by the oral route is available. Use must be restricted to situations in which the risks are outweighed by potential benefits. Limiting pediatric use will slow down the emergence of resistant bacteria.

Child↗
PubMed2001

[Cardiac rhythm disturbances and prolonged QT interval with halofantrine].

OBJECTIVE: To determine the importance of prolonged QT interval and electrocardiographic changes in children treated with halofantrin for an acute malaria attack. RESULTS: Out of 25 children treated with halofantrin, nine had an increase of QTc interval < 440 ms and ten a QTc > 440 ms on control 24 h after the first dose. A 9-year-old girl, treated with halofantrin, had bradycardia and increase of QTc interval for six days, with a normal halofantrin blood level. CONCLUSION: These data show that cardiac monitoring during halofantrin treatment is mandatory in children as in adults. Contraindications of halofantrin treatment must be respected, particularly a long congenital QT interval.

Adolescent↗
PubMed2001

[Severe cutaneous Streptococcus pyogenes infections in the child: results of a multicenter survey].

UNLABELLED: To assess pediatric cases of severe cutaneous infections due to Streptococcus pyogenes. Since the beginning of 1980, the incidence of cellulitis and necrotizing fasciitis due to S. pyogenes has increased in adults. Serotyping of obtained isolates are in most cases M1, M3 or M5 protein. PATIENTS AND METHOD: A retrospective (1990-2000) survey was carried out in pediatric hospital centers. RESULTS: Three cases of necrotizing fasciitis and 15 of cellulitis were observed. In 30% of the cases, vancella lesions were associated; in the other cases, minor wounds were the site of the infection. Bacteriologic diagnosis was made by local samples in 14 cases; blood cultures were positive in four cases. In 11 cases, initial intravenous treatment consisted of third generation cephalosporin, in six cases of penicillin M or G and in one case of fusidic acid. In the second time, penicillin M was perfused in the majority of the cases. Mean duration of intravenous antibiotics perfusion was 15 days. There were no sequelae or death in this survey. CONCLUSIONS: Despite this study had limited epidemiological characteristics, it confirms that these two infections are rare. The frequency is probably underestimated, due to the difficulty in performing a diagnosis. The major site of infection was the varicella lesion. These two infections are so similar that it is frequent to mistake one infection for the other. Nonsteroidal anti-inflammatory drugs and site of infections did not influence prognosis. The treatment of cellulitis is penicillinotherapy whereas in necrotizing fasciitis early major surgery is often correlated with the rate of survival.

Cellulitis↗
PubMed2001

[Impact of bacterial resistance on severe infections].

Since many years, the antimicrobial resistance increases as well as for community-acquired as for nosocomial infections. Antibiotic-resistant pneumococci are neither more nor less virulent susceptible strains. Except for immunocompromised patients, the outcome of penicillin-resistant pneumococcal infections have been similar to those in patients who are infected by susceptible ones. Current levels of S. pneumoniae resistance to penicillin and cephalosporin are not associated to an increase in mortality in children with meningitis if adequate doses of antibiotics are given. Because empiric therapy has changed, antibiotic resistance has not been associated with increased mortality. This statement can be extended to Meningococcus, for which 32 to 50% of the strains have a decreased susceptibility to penicillin. For nosocomial infections, S. aureus is the main studied pathogen. Several studies report that in patients with severe diseases (bacteremia or pneumonia) methicillin resistance of S. aureus had no significant impact on patient outcome after adjustment for different confounders. The main risk factor for mortality is the severe underlying diseases rather than the resistance as well for methicillin--resistant S. aureus, as for vancomycin resistant enterococci, Klebsiella with extended spectrum beta lactamase and Enterobacters. Recommendations for controlling epidemiologic surveillance, using barrier precautions and limiting the use of antibiotics as well in the hospital as in the community must be undertaken.

Anti-Bacterial Agents↗
PubMed2001

Isoniazid pharmacokinetics in children according to acetylator phenotype.

The pharmacokinetics of isoniazid (INH) was studied in children (0-196 months old) according to their acetylator phenotype, estimated from the metabolic acetyl INH/INH molar plasma concentration ratio (MR) measured 3 h after INH oral administration. There were 17 slow (MR < 0.48) and 17 fast acetylators (MR > or = 0.48). The mean apparent plasma clearance was significantly lower, the mean apparent volume of distribution higher and the half-life longer in the slow acetylator group (C1, 0.298 +/- 0.099 L/h/kg; Vd, 1.56 +/- 0.65 L/kg; t1/2, 3.88 +/- 01.89 h) than in the fast acetylator group (Cl, 0.528 +/- 0.234 L/h/kg; Vd, 1.06 +/- 0.45; t1/2, 1.64 +/- 1.1 h). The half-life decreased with age. An impaired isoniazid elimination was suggested in children less than three months old, which may be in favour of an individual dose adjustment in this population.

Acetylation↗
PubMed2001

Nasopharyngeal colonization by Haemophilus influenzae in children living in an orphanage.

AIM: To study colonization and transmission of Haemophilus influenzae in a cohort of children <2 years old living in the unique epidemiologic conditions of a closed community of an orphanage. METHODS: Fifty-three children, ages 0 to 24 months, were followed for 1 year. All children >2 months were vaccinated against H. influenzae serotype b. Nasopharyngeal cultures were collected monthly or, in children <6 months of age, every 2 weeks. Antibiotic susceptibility, serotype, biotype and genotype (pulsed field gel electrophoresis) of each isolate were determined. As control, 39 H. influenzae isolates were recovered from various regions in France. RESULTS: The mean monthly rate of carriage was 45% ranging from 17 to 70%. Most isolates belonged to biotype II (62%), 4 isolates to serotype f (3.6%) and none to serotype b, and 60% of the 111 isolates produced beta-lactamase. A complete concordance was found among biotype, serotype, pulsotype and antimicrobial susceptibility. On average children were sequentially colonized by 3 different isolates. The mean duration of carriage for a given isolate was approximately 1.4 months. In younger children the mean age of primary colonization was 2 months. Contrasting with the high genetic heterogeneity of 39 control isolates, most isolates (82%) belonged to only 5 pulsotypes. Three main H. influenzae clones rapidly spread in the community and colonized children in waves. CONCLUSION: During early life nasopharyngeal colonization by H. influenzae is a dynamic phenomenon with sequential carriage of various clones spreading in the community.

Carrier State↗
PubMed2001

Procalcitonin in children admitted to hospital with community acquired pneumonia.

AIMS: To assess the sensitivity, specificity, and predictive value of procalcitonin (PCT) in differentiating bacterial and viral causes of pneumonia. METHODS: A total of 72 children with community acquired pneumonia were studied. Ten had positive blood culture for Streptococcus pneumoniae and 15 had bacterial pneumonia according to sputum analysis (S pneumoniae in 15, Haemophilus influenzae b in one). Ten patients had Mycoplasma pneumoniae infection and 37 were infected with viruses, eight of whom had viral infection plus bacterial coinfection. PCT concentration was compared to C reactive protein (CRP) concentration and leucocyte count, and, if samples were available, interleukin 6 (IL-6) concentration. RESULTS: PCT concentration was greater than 2 microg/l in all 10 patients with blood culture positive for S pneumoniae; in eight of these, CRP concentration was above 60 mg/l. PCT concentration was greater than 1 microg/l in 86% of patients with bacterial infection (including Mycoplasma and bacterial superinfection of viral pneumonia). A CRP concentration of 20 mg/l had a similar sensitivity but a much lower specificity than PCT (40% v 86%) for discriminating between bacterial and viral causes of pneumonia. PCT concentration was significantly higher in cases of bacterial pneumonia with positive blood culture whereas CRP concentration was not. Specificity and sensitivity were lower for leucocyte count and IL-6 concentration. CONCLUSIONS: PCT concentration, with a threshold of 1 microg/l is more sensitive and specific and has greater positive and negative predictive values than CRP, IL-6, or white blood cell count for differentiating bacterial and viral causes of community pneumonia in untreated children admitted to hospital as emergency cases.

Adolescent↗
PubMed2001

Fluoroquinolones in paediatrics.

The fluoroquinolones are an important group of antibiotics, which are widely used in adult patients because of their high penetration in tissues and bactericidal activity. However, they are not licensed for paediatric use (except the limited indication of Pseudomonas infection in cystic fibrosis) because of their potential to cause joint toxicity (observed in experiments using juvenile animal models). In recent years, there has been a change in the susceptibility of pathogens to widely used antibiotics; however, many of these pathogens remain sensitive to the fluoroquinolones (agents which can often be administered orally to treat severe infections). Fluoroquinolones have a number of potential indications in children: cystic fibrosis, intestinal infections due to resistant strains of Salmonella spp. and Shigella spp., severe infections due to Enterobacteriaceae (including the neonatal period), complicated urinary tract infections, the immunocompromised host, and some mycobacterial infections. The third generation fluoroquinolones have improved activity against Gram-positive bacteria and could be useful in respiratory tract, and ear, nose and throat infections in adult patients. Their potential role in routine use for paediatric patients will remain limited because of potential joint complications and the availability of other treatment options. However, available clinical data does indicate that the incidence of arthrotoxicity in children treated with ciprofloxacin appears to be the same as that in adult patients. The use of other fluoroquinolones is too rare to obtain meaningful information on their toxicity in children. For future fluoroquinolones, pneumococcal meningitis will probably be a potential indication. Despite their important activity, fluoroquinolones remain a second-line treatment in children, for use following the failure of a well established antibiotic treatment, to avoid potential adverse effects and the emergence of resistant strains.

Anti-Infective Agents↗
PubMed2000

Sequential colonization by Streptococcus pneumoniae of healthy children living in an orphanage.

A prospective study of nasopharyngeal colonization by Streptococcus pneumoniae in the exceptional conditions of a closed community of abandoned children was done over a 1-year period; 71 children (age <24 months) were studied monthly. S. pneumoniae was isolated from 58 (81.7%), and 94.5% of the 111 isolates were resistant to penicillin. The mean rate of carriage was estimated at 57.4%, ranging from 42.8% to 70.4%. Children were sequentially colonized by a mean of 3 different isolates. The mean duration of carriage for a given isolate was approximately 2.2 months. Serotyping and molecular typing by pulsed-field gel electrophoresis showed that children were colonized by a limited number of clones belonging to only 4 serotypes and 4 pulsotypes. These clones rapidly spread in the community and colonized the children in waves, with a rapid turnover of S. pneumoniae isolates, facilitated by close contact between children.

Electrophoresis, Gel, Pulsed-Field↗
PubMed2000

[Procalcitonin in pediatric emergencies: comparison with C-reactive protein, interleukin-6 and interferon alpha in the differentiation between bacterial and viral infections].

OBJECTIVE: Procalcitonin concentration increases in bacterial infections but remains low in viral infections and inflammatory diseases. The change is rapid and the molecule is stable making it a potentially useful marker for distinguishing between bacterial and viral infections. PATIENTS AND METHODS: Procalcitonin (PCT) was determined with an immunoluminometric assay on plasma collected at admission in 436 infants and children hospitalized for bacterial or viral infection. It was compared with C reactive protein, interleukin-6 and interferon-alpha measured on the same sample. RESULTS: PCT was 41.3 +/- 77.4 micrograms/l in children with septicemia or bacterial meningitis (n = 53), 0.39 +/- 0.57 microgram/l in children with viral infection (n = 274) and 3.9 +/- 5.9 micrograms/l in children with a localized bacterial infection who had a negative blood culture (n = 109). PCT was > 1 microgram/l in 126 children with a localized or systemic bacterial infection (sensitivity 78%). PCT was < 1 microgram/l in 258 children with a viral infection (specificity 94%). For differenciation between viral and bacterial infections, CRP value > or = 20 mg/l, IL-6 > 100 pg/ml and interferon-alpha > 0 Ul/ml have 85, 48 and 76% sensitivity and 73, 85 and 92% specificity respectively. CONCLUSIONS: In this study, a PCT value of 1 microgram/l or greater had better specificity, sensitivity and predictive value than CRP, IL-6 and interferon-alpha in children for distinguishing between viral and bacterial infections. PCT may be useful in pediatric emergency room for making decision about antibiotic treatments.

Adolescent↗