Compliance with the current recommendations for prescribing antibiotics for paediatric community-acquired pneumonia is improving: data from a prospective study in a French network

International audienceBACKGROUND: Lower respiratory tract infection is a common cause of consultation and antibiotic prescription in paediatric practice. The misuse of antibiotics is a major cause of the emergence of multidrug-resistant bacteria. The aim of this study was to evaluate the frequency, changes over time, and determinants of non-compliance with antibiotic prescription recommendations for children admitted in paediatric emergency department (PED) with community-acquired pneumonia (CAP).METHODS: We conducted a prospective two-period study using data from the French pneumonia network that included all children with CAP, aged one month to 15 years old, admitted to one of the ten participating paediatric emergency departments. In the first period, data from children included in all ten centres were analysed. In the second period, we analysed children in three centers for which we collected additional data. Two experts assessed compliance with the current French recommendations. Independent determinants of non-compliance were evaluated using a logistic regression model. The frequency of non-compliance was compared between the two periods for the same centres in univariate analysis, after adjustment for confounding factors.RESULTS: A total of 3034 children were included during the first period (from May 2009 to May 2011) and 293 in the second period (from January to July 2012). Median ages were 3.0 years [1.4-5] in the first period and 3.6 years in the second period. The main reasons for non-compliance were the improper use of broad-spectrum antibiotics or combinations of antibiotics. Factors that were independently associated with non-compliance with recommendations were younger age, presence of risk factors for pneumococcal infection, and hospitalization. We also observed significant differences in compliance between the treatment centres during the first period. The frequency of non-compliance significantly decreased from 48 to 18.8 % between 2009 and 2012. The association between period and non-compliance remained statistically significant after adjustment for confounding factors. Amoxicillin was prescribed as the sole therapy significantly more frequently in the second period (71 % vs. 54.2 %, p < 0.001).CONCLUSIONS: We observed a significant increase in the compliance with recommendations, with a reduction in the prescription of broad-spectrum antibiotics, efforts to improve antibiotic prescriptions must continue

Enquête épidémiologique sur les facteurs de risque socio-démographiques de mauvaise observance de prophylaxie du rachitisme chez l'enfant de 0 à 5 ans réalisée aux urgences pédiatriques du CHU de Nantes en 2009

Malgré les recommandations de 1963-1971 concernant la prescription de vitamine D chez l'enfant de moins de 6 ans en France, des cas de rachitisme sont encore diagnostiqués aujourd'hui. Afin de pouvoir cibler les enfants à risque de mauvaise prophylaxie antirachitique et d'améliorer leur prise en charge, une étude observationnelle a été réalisée en 2009 aux urgences pédiatriques de Nantes qui a permis d'inclure 198 enfants de moins de 6 ans. Sur l ensemble de la cohorte étudiée, 48% des enfants ont des prescriptions non conformes. Après analyse multivariée, les facteurs de risque indépendants d'apports en vitamine D non conformes sont l'absence d allaitement maternel exclusif et le type de médecin prescripteur pour les enfants de moins de 18 mois et l'absence de consommation de laits et produits laitiers enrichis en vitamine D ainsi que la peau claire pour les enfants de 18 mois à 5 ans. Avant 18 mois, les erreurs de prescription sont essentiellement des erreurs par excès sans risque de toxicité alors que pour les plus de 18 mois, ce sont des erreurs par défaut qui exposent au risque de rachitisme. Une attention particulière doit donc être apportée d'une part aux enfants de moins de 18 mois qui ne bénéficient pas d'allaitement maternel exclusif afin d éviter des apports en vitamine D excessifs et inutiles, et d'autre part aux enfants de plus de 18 mois et notamment ceux de peau claire et ceux ne consommant pas de laits et produits laitiers enrichis qui sont exposés au risque de rachitisme.NANTES-BU Médecine pharmacie (441092101) / SudocSudocFranceF

Les plaintes floues des adolescents (prise en charge de plaintes somatiques non organiques à partir d observations recueillies en hospitalisation pédiatrique)

Un motif fréquent de consultations des adolescents auprès des professionnels de santé est la plainte fonctionnelle : un ressenti physique suggérant une maladie somatique, mais sans pathologie organique démontrée . Notre étude rétrospective analyse les observations de 20 adolescents, hospitalisés dans le service de pédiatrie du Centre Hospitalier Universitaire de Nantes, pour un symptôme flou . Cette étude souligne l importance et la difficulté parfois d exclure une étiologie organique devant ces symptômes et donc la nécessité d une approche globale psychosomatique. En effet, ces plaintes renvoient souvent à des difficultés psychologiques ou psychosociales et constituent un langage codé pour traduire un mal-être beaucoup plus général, qu il importe de dépister et de prendre en charge. Le corps devient un moyen d expression. Il n existe probablement pas de réponse univoque, mais notre étude, appuyée de données de la littérature, a voulu proposer quelques orientations thérapeutiques.NANTES-BU Médecine pharmacie (441092101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

La dengue en zone caraïbe

PARIS-BIUP (751062107) / SudocSudocFranceF

Do Abused Young Children Feel Less Pain?

International audienceThe objective of this study was to investigate whether acute pain in abused children was under recognized by doctors and nurses compared to children evaluated for accidental injuries. We hypothesize that an abused child's reaction to physical pain could be an additional symptom of this challenging diagnosis. For the observational prospective case control study in an emergency department, children were eligible when: younger than six years old, the reported trauma occurred within the previous seven days, the trauma comprised a bone injury or burn, and the child was able to express his or her pain. The case group comprised children for whom the medical team reported their abuse suspicions and supporting information to a court, and whose cases of abuse were subsequently confirmed. The control group consisted of children with a plausible cause for their injury and no obvious signs of abuse. The children were matched according to their age and type of trauma. The pain was assessed by doctors and nurses before analgesic administration using a certified pain scale. Among the 78 included children, pain was significantly less recognized in the abused children vs. the controls (relative risk=0.63; 95% CI: 0.402-0.986; p=0.04). We observed a discrepancy between the nurses' and doctors' scores for the pain assessments (Kappa coefficient=0.59, 95% CI: 0.40-0.77). Our results demonstrate that pain expression in abused children is under recognized by medical staff. They also suggest that abused children may have reduced pain expression after a traumatic event. Paying particular attention to the pain of abused children may also optimize the analgesic treatment

Management of severe asthma exacerbation: guidelines from the Société Française de Médecine d’Urgence, the Société de Réanimation de Langue Française and the French Group for Pediatric Intensive Care and Emergencies

International audienceThe French Emergency Medicine Society, the French Intensive Care Society and the Pediatric Intensive Care and Emergency Medicine French-Speaking Group edited guidelines on severe asthma exacerbation (SAE) in adult and pediatric patients

Effect of Nebulized Hypertonic Saline Treatment in Emergency Departments on the Hospitalization Rate for Acute Bronchiolitis

International audienc