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Y Aujard

Publications and source records attributed to Y Aujard.

At least 37 records · Page 2Linked to original sources
PubMed2001

[Severe neonatal bacterial infections].

The prognosis of septicemic forms of early and late neonatal sepsis is severe with a high rate of mortality especially in premature infants. The evaluation of severity is difficult because of the non specificity of the clinical signs and mortality seems to be a good means of evaluation. A study was conducted in France on the mortality due to infection in neonatal intensive care units and neonatology wards during the third trimester 2000. Among 18 units, the mortality rate was 9.3% of admissions, corresponding to 11 early onset sepsis and 17 nosocomial infections. Death in primitive infections is essentially due to group B streptococci and E. coli with a more important risk in low gestational age infants. The nosocomial infections arise almost only in premature infant. Prognosis of infections due to Staphylococcus coagulase negative staphylococci, most frequent pathogens is good but mortalities rate is higher for enterobacteriacae--40% and for Pseudomonas, 62%.

Bacterial Infections↗
PubMed2001

Pharmacokinetics of oral acyclovir in neonates and in infants: a population analysis.

Acyclovir is approved for the treatment of herpes simplex virus (HSV) and varicella-zoster virus (VZV) infections in children by the intravenous and oral routes. However, its use by the oral route in children younger than 2 years of age is limited due to a lack of pharmacokinetic data. The objectives of the present study were to determine the typical pharmacokinetics of an oral suspension of acyclovir given to children younger than 2 years of age and the interindividual variabilities in the values of the pharmacokinetic parameters in order to support the proposed dosing regimen (24 mg/kg of body weight three times a day for patients younger than 1 month of age or four times a day otherwise). Children younger than age 2 years with HSV or VZV infections were enrolled in a multicenter study. Children were treated for at least 5 days with an acyclovir oral suspension. Plasma samples were obtained at steady state, before acyclovir administration, and at 2, 3, 5, and 8 h after acyclovir administration. Acyclovir concentrations were measured by radioimmunoassay. The data were analyzed by a population approach. Data for 79 children were considered in the pharmacokinetic study (212 samples, 1 to 5 samples per patient). Acyclovir clearance was related to the estimated glomerular filtration rate, body surface area, and serum creatinine level. The volume of distribution was related to body weight. The elimination half-life decreased sharply during the first month after birth, from 10 to 15 h to 2.5 h. Bioavailability was 0.12. The interindividual variability was less pronounced when the parameters were normalized with respect to body weight. Hence, dosage adjustment by body weight is recommended for this population. Simulations showed that the length of time that acyclovir remains above the 50% inhibitory concentration during a 24-h period was more than 12 h for HSV but not for VZV. The proposed dosing regimen seems adequate for the treatment of HSV infections, while for the treatment of VZV infections, a twofold increase in the dose seems necessary for children older than age 3 months.

Acyclovir↗
PubMed2001

[Neonatal bacterial infection by maternal-fetal contamination: for a change in approach? 1. Detection of Streptococcus agalactiae infection: methods and evaluation of results].

Perinatal group B streptococcal infection has been the subject of numerous studies and despite guidelines established during the last decade remains a frequent disease with high mortality. The basic aim of the guidelines is to screen for Streptococcus agalactiae during the antepartum period in order to institute antibiotic therapy during delivery. A critical review of the literature highlights the real impact and adverse effect of these guidelines: difficult application (only two-thirds of all maternity units have a protocol and compliance is only 75%), maternal risks of antibiotic therapy (especially the emergence of resistant Gram negative bacteria), fetal risks (accentuation of neonatal sepsis with resistant strains, retarded neonatal infections, frequent use of antibiotics with a broader spectrum, higher frequency of nosocomial sepsis).

Anti-Bacterial Agents↗
PubMed2001

[Neonatal bacterial infection by maternal-fetal contamination: for a change in approach? 2. Uncertainties and proposals].

Based on a critical analysis of the literature, it is clear that even though mortality has decreased to 10-15%, the prevalence of neonatal bacterial infections remains dramatically stable. Precise risk factors can be identified in most cases of neonatal infection, but remain uncertain in many others: Streptococcus agalactiae is found in only 40% of the cases of sepsis; Escherichia coli, Haemophilus influenzae, Pneumococcus, and group A Streptococcus strains should also be considered for a real prophylactic strategy; context (prematurity), lack of a consensual attitude for intrapartum strategies; management schemes for asymptomatic neonates. Based on these observations, we make proposals for a realistic attitude for everyday practice based on risk factors, maternal and neonatal bacterial sampling procedures, and modalities for neonatal antibiotic therapy.

Anti-Bacterial Agents↗
PubMed2000

Ilio-psoas abscess in neonates: treatment by ultrasound-guided percutaneous drainage.

Ilio-psoas abscess is rare in neonates and is usually treated by surgical drainage. We report two cases of ilio-psoas abscess in 15- and 21-day-old infants successfully treated by US-guided percutaneous drainage as a supplement to antibiotic therapy. Clinical improvement was observed within 24-48 h of drainage and subsequent imaging demonstrated resolution of the abscess cavity. The analysis of these cases and of those previously reported indicates that imaging is essential for diagnosis. In neonates, US-guided percutaneous drainage may represent the first-choice treatment of this disease in association with antibiotic therapy.

Age Factors↗
PubMed2000

Nosocomial infections in pediatric patients: a European, multicenter prospective study. European Study Group.

OBJECTIVES: To determine the site and bacterial epidemiology of nosocomial infections (NIs) in children. DESIGN: 6-month prospective study with periodic chart review during hospitalization using a uniform prospective questionnaire in each unit, analyzed at a coordinating center. SETTING: 20 units in eight European countries: 5 pediatric intensive care units (PICUs), 7 neonatal units, 2 hematology-oncology units, 8 general pediatric units. PARTICIPANTS: All children hospitalized during the study period with an NI according to Centers for Disease Control and Prevention criteria. RESULTS: The overall incidence of NI was 2.5%, ranging from 1% in general pediatric units to 23.6% in PICUs. Bacteria were responsible for 68% (gram-negative bacilli, 37%; gram-positive cocci, 31%), Candida for 9%, and viruses for 22% of cases. The proportion of lower respiratory tract infections was 13% in general pediatric units and 53% in PICUs. Bloodstream infections were most frequent in neonatal units (71% of NIs) and were associated with a central venous catheter in 66% of cases. Coagulase-negative Staphylococcus (CNS) was the main pathogen. Eleven percent of NI were urinary tract infections. Gastrointestinal infections were most commonly viral and accounted for 76% of NIs in general pediatric units. The prevalence of antimicrobial resistance depended on the type of unit. The highest rates were observed in PICUs: 26.3% of Staphylococcus aureus and 89% of CNS were methicillin-resistant, and 37.5% of Klebsiella pneumoniae had an extended-spectrum beta-lactamase. Mortality due to NI was 10% in PICUs and 17% in neonatal units. CONCLUSIONS: We found large differences in NI frequency and microbial epidemiology in this European study. Viruses were the main pathogens in general pediatrics units. Catheter-related sepsis and CNS were frequent in newborns. A high frequency of multiresistant bacteria was observed in some units. Clinical monitoring of NIs and bacterial resistance profiles are required in all pediatric units.

Child↗
PubMed2000

[Nosocomial infections in pediatrics. Problems and perspectives].

High incidence of nosocomial infections in children is largely explained by immunodeficiency, particularly in newborns. Central venous catheter is the main risk factor and coagulase negative staphylococcus the main pathogen in cause. Large variations of nosocomial infection incidences are observed by Nososcomial Infection Surveillance Networks and depend on the pediatric speciality. The highest rate is observed in neonatal intensive care, where incidence density of catheter-related sepsis varies from four to 23 infections for 1000 catheter-days. Local surveillance in each ward, risk factors and knowledge of bacterial epidemiology allow the development of rational preventive and therapeutic protocols. However, prophylactic use of vancomycin is dangerous and immunoglobulins are inefficient.

Catheterization, Central Venous↗
PubMed1999

[Bacterial concentration in the cerebrospinal fluid in childhood meningitis].

OBJECTIVES: The aim of this study was to analyze the epidemiological evolution of causal germs in meningitis in children aged 1 day to 15 years and determine the relationship between pretreatment concentrations of bacteria in cerebral spinal fluid (CSF), patient age, bacterial species and bacteriological eradication. PATIENTS AND METHODS: A quantitative analysis of germs was performed in 212 children with bacterial meningitis (mean age 19.8 months). RESULTS: Bacterial counts ranged from 2.10(1) to 4.10(9) CFU/ml in CSF. Among the 212 patients, 52 (24.5%) had counts 10(7)/ml. Infants had significantly higher counts than the other age groups. Mean counts for Hoemophilus influenzoe serotype B were not different from those for Streptococcus pneumoniae but were significantly higher than for Neisseria meningitidis. Compared with initial germ counts, 98.5% of the CSF specimens were sterile at 24 and 48 hours and 100% at 72 hours. CONCLUSION: Germ counts were higher in infants.

Adolescent↗
PubMed1999

[Neonatal alloimmune neutropenias. Importance of treatment with granulocyte colony-stimulating factor (G-CSF). Report of 2 new cases].

UNLABELLED: Alloimmune neonatal neutropenia is a rare event. Usually asymptomatic, it may however in some cases result in a severe sepsis. Treatment with recombinant granulocyte colony-stimulating factor (G-CSF) has been recently proposed. CASE REPORT: We report two new cases in infected newborns of a successful treatment of alloimmune neonatal neutropenia with G-CSF, resulting in complete neutrophil recovery in less than 72 hours. Moreover, the treatment was well tolerated. CONCLUSION: The analysis of these two cases and of those previously reported indicates that G-CSF represents the first-choice treatment in this affection when infectious signs are present in the neonate.

Age Factors↗
PubMed1998

[Intracranial hypertension in a newborn treated with quinolone].

BACKGROUND: Fluoroquinolones have not received administrative authorization for use in children, but because of multiresistant pathogens in neonatal intensive care, floroquinolones may be the only alternative. CASE REPORT: A premature infant exclusively nourished by parenteral nutrition developed enterobacteria sepsis. Ceftazidine was given initially but resistance led to the prescription of fluoroquinolone. Signs of intracranial hypertension developed 3 days after onset of fluoroquinolone treatment and regressed 48 hours after its withdrawal. DISCUSSION: The main potential adverse effects with fluoroquinone in the newborn are arthropathy, photosensitivity, discoloration of the teeth and neurological disorders. Intracranial hypertension is a known complication of nalidixic acid both in adults and children, but to our knowledge has not been previously with floroquinolone in the newborn.

4-Quinolones↗
PubMed1998

[Urinary tract infection in the newborn infant].

Urinary tract infection in the first month of life may be revealed by isolated fever, poor weight gain or severe sepsis. It is more frequent in male infants. Escherichia coli is the most common infecting agent. A urinary tract malformation is found in approximately 30% of the cases. In most cases intravenous treatment with an association of cephalosporin and aminoside is efficient. However, because of the possible involvement of an enterococcus, amoxicillin must be added until the result of the urine culture is available. Prophylaxis with oral administration of antibiotics is recommended in case of urinary tract malformation.

Anti-Bacterial Agents↗
PubMed1998

[Retrospective survey of fluoroquinolone use in children].

BACKGROUND: Fluoroquinolones (FQ) are contraindicated in children because of the risk of cartilage damage. POPULATION AND METHODS: A retrospective survey concerning the use of FQ in children during the first 6 months of 1993 was organized in 1994. One hundred and sixty-seven Heads of pediatric departments were questioned. RESULTS: One hundred and fifty (90%) of those surveyed responded: 62 (41.3%) were FQ prescribers, 83 (55.3%) were non prescribers and five (3.4%) were not able to answer. Among the 62 prescribers of FQ, 17 departments (27%) were not able to indicate the number of prescriptions and 45 departments (73%) reported one to 75 prescriptions during the study period. Twenty-one departments out of the 45 were not able to identify the children treated with FQ. We obtained a group of 104 children aged 9.0 +/- 5.0 years (mean +/- standard deviation [SD]), treated with 165 courses of FQ during 20 +/- 45 days (1-535 days) with concomitant treatments for 132/165 courses (80%). Fifty children (48%) were suffering from cystic fibrosis, 37 children (36%) were not, and, in 17, the diagnosis was not determined (16%). The FQ treatment administered either orally (73%) or intravenously (26%) was ciprofloxacin in 69% of the courses with a 25.1 +/- 7.0 mg/kg/day oral dose (mean +/- SD dose), and a 23.5 +/- 11.4 mg/kg/day intravenous dose, pefloxacin in 23 courses/165 (14%) with a 17.2 +/- 3.8 mg/kg/day dose, ofloxacin in 15 courses/165 (9%) with a 21.0 +/- 11.9 mg/kg/day dose, norfloxacin in 13 courses/165 (8%) with a 25.6 +/- 7.5 mg/kg/day dose. Twenty-one adverse events were reported in 17 children (16%) (11 of them with cystic fibrosis). These were cutaneous events (photosensitivity, cutaneous eruption) in eight courses, rheumatologic events (arthralgia, arthritis) in seven courses and gastrointestinal events (nausea, vomiting, diarrhea) in three courses. CONCLUSION: This survey shows that FQ are prescribed in children although their use is not approved in this age group and that numerous side effects have been recorded. The absence of exhaustive information (due to the retrospective nature of the survey) and the difficulties in interpreting the side effects for which validity and causal assessment have not been worked out according to a standardized method and in the absence of a control group stress the need for a prospective study.

Adolescent↗