Anaesthesist 2001 Aug;50(8):620-1
Anasthesiologische Klinik, Klinikum der Ludwig-Maximilians-Universitat, Marchioninistrasse 15, 81377 Munchen. gregor.kemming@icf.med.uni-muenchen.de
PMID: 11556176, UI: 21440812
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Arch Pediatr 2001 Sep;8 Suppl 4:712s-720s
SMUR pediatrique, Hopital Necker-Enfants-Malades, 149, rue de Sevres, 75743 Paris, France.
This study involves 106 infants (neonatal period ruled out), victims of severe bacterial infections managed from 1st january 1998 to 30 April 2001 by the four paediatric Mobile Intensive Care Unit (P.M.I.C.U.) teams AP-HP in Ile-de-France area. 46.2% of the whole infants are primary interventions (home, medical room, airport) and primary-secondary interventions (hospital emergencies) whereas 53.8% are related to secondary transports of infants who have been hospitalized and suffered from severe bacterial disorders complicating their original disease. 51% are meningitidis infections, rather due to streptococcus pneumoniae and meningococcis, associated with severe infectious purpura. 20.75% are toxic shock syndromes in patients suffering from chronic affections (sickle cell anemia), acquired or congenital immunodeficiencies; 19.8% of the cases are severe bacterial pneumonia (staphylococcal pleuro-pneumopathies, bordetella pertussis cough) or surinfected viral infections (VRS bronchiolitis, pneumonia due to mycoplasma pneumoniae and para-influenzae III). Authors study various characteristics of the two patient's groups, their immediate management by local medical team and by the P.M.I.C.U. team, their early term outcome. 65% of children recovered apparently without sequelae, 19% died, and 16% healed but with significant sequelaes, notably neurological damage. Meningitidis due to Streptococcus pneumoniae are particularly severe, because of their prognostic (10 deaths, 8 severe sequelae among the 26 cases). These observations prompted us to recommend early immunization of infants at 2-3 months post natal age by the new vaccine conjugated up to 7 valences such as "Prevenar". If this vaccine have been available for this patient series, may be avoided 8 deaths, 7 severe sequelae, with 1 septic shock syndrome due to streptococcus pneumoniae and another serious infection in a homozygous sickle cell disease.
PMID: 11582917, UI: 21467502
Arch Pediatr 2001 Sep;8 Suppl 4:705s-711s
Service d'urgence et de reanimation pediatriques, hopital Edouard-Herriot, place d'Arsonval, 69437 Lyon, France. daniel.floret@chu-lyon.fr
A retrospective survey has been conducted in the Pediatric Intensive Care Units (PICUs) affiliated to the Groupe Francophone d'Urgence et de Reanimation Pediatrique over two years (1999 and 2000). The purpose was to determine the number of children aged from 10 days to 18 years who died from community acquired bacterial infections and to compare the data to those obtained from official surveys (statistics of death from the Institut National de la Sante et de la Recherche Medicale) and from the Institut National de Veille Sanitaire as well as from punctual studies. Thirty two (60%) PICUs have participated and 100 cases of children without known risk factors, dead from community acquired documented bacterial infection have been considered for analysis (36 in 1999, 54 in 2000). Infants aged between 10 days and 2 months represent 1/3 of the fatalities. Neisseria meningitidis is the first pathogen responsible for death (34% including 10 not documented cases of purpura fulminans). B group is predominant (14/24) compared to the C group (6 cases). A lethal infection due to W135 group occurred in 2 infants in 2000. Streptococcus pneumoniae is the second pathogen responsible for death (28%). None of the cases were due to antibiotic resistant pneumococcus. Bordetella pertussis is surprisingly the third pathogen responsible for death (13%), all of them being younger than 2 months. Pertussis is the first cause of death in infants aged 10 days-2 months. An important increase was observed between 1999 (3 cases) and 2000 (10 cases). Meningitis is the first disease responsible for death (42%): 26 are related to pneumococcus, 5 to meningococcus and 6 to group B streptococcus. Purpura fulminans is the second cause (30%), due mainly to group B meningococcus (11 cases). Group C meningococcus accounts for 6 cases only. One case is related to pneumococcus. Lung infections are a rare cause of death (5 cases) and particularly staphylococcal pleuro pneumonia seems to be no longer a significative cause of fatality. Toxic shock syndrome is an emergent disease responsible for 5 death (2 staphylococcal, 3 streptococcal). These data fit with those provided by the Institut National de Veille Sanitaire with respect to meningococcal infections and the Renacoq network with respect to pertussis, as well as the data provided by a previous GPIP survey on pneumococcal meningitis. However, the data provided by INSERM seem not to be relevant. In spite of the bias due to a retrospective study and the lack of exhaustivity, this survey provides data which could help decision making with respect to new vaccines against pneumococcus.
PMID: 11582916, UI: 21467501
Arch Pediatr 2001 Sep;8 Suppl 4:665s-672s
Service de reanimation pediatrique, Hopital du Kremlin-Bicetre, 78, rue du General Leclerc, Le Kremlin-Bicetre 94275, France. gilbert.huault@free.fr
Intensive care and especially pediatric intensive care originated in connection with fatal forms of infectious diseases, some forty years ago. It has come a long way during the last quarter of the past century. Several infectious diseases have disappeared in France during this period such as poliomyelitis, dipteria and tetanus. Many other are receding. Nevertheless problems remain: serious infections by pneumococcus or staphylococcus, maternofoetal infections, whooping cough in very young infant. Now, thanks to liver transplantations and intensive care, the fatal forms of infectious hepatitis can be overcome in more than 50% of the cases. Meanwhile HIV appeared involving intensivists participation. Toxic shock, and especially the purpura fulminans, remains a major difficulty. Great advances in understanding its mechanisms have been made and it seems today like the result of excessive and unsuitable defence reactions. In addition, intensive care takes charge of more and more vulnerable ill persons: immunosuppressed, extreme premature babies, children who had to undergo heavy operations. In those cases, intensive care faces superinfections, nosocomial infections, multi-resistant germs, related in part to the particular working and environmental conditions and an unsuitable use of antibiotics. To conclude, it is necessary to optimize the technical and working conditions in intensive care units, to strictly observe the well established regulations of hygienics and to develop vaccinations.
PMID: 11582911, UI: 21467496
JAMA 2001 Sep 26;286(12):1498-505
Department of Neonatology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA. drichard@caregroup.harvard.edu
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PMID: 11572744, UI: 21457064
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