mercredi 5 février 2020 

14h10 - 15h10


 
Espace Poster 1

Pédiatrie I

MODÉRATEUR(S) :  David BROSSIER (Caen), Isabelle GOYER (Caen)  
  

Use of aminoglycosided in a French pediatric hospital : a retrospective study

Orateur(s) :   Séverine MANEN (Grenoble) 

Auteur(s) :  Cécile BOST-BRU (Grenoble)   Sébastien CHANOINE (Grenoble)   Guillaume MORTAMET (Grenoble)  

14h10 - 14h17
Durée de la présentation : 4 min
Durée de la discussion : 3 min


Abstract : 
Use of aminoglycosided in a French pediatric hospital : a retrospective study

Introduction / Rationale :
Since aminoglycosides are well-known for their synergic action with betalactams and their narrow spectrum, they are largely used in acute settings. However, due to the emergence of multi resistance drug bacteria, their use should be limited to specific indications. Since the publication of French recommendations in 2011, some adult studies revealed that aminoglycosides are still misused. Despite the pharmacological and physiological specificities in the pediatric population, there is a lack of data in this field in children. This study aims to describe the use of aminoglycoside prescriptions in a pediatric center.

Méthodes / Patients and Methods :
A single center retrospective study performed in a tertiary hospital. All patients under 18 years old who received at least one intravenous dose of aminoglycosides (amikacin or gentamicin) at the Pediatric Intensive Care Unit (PICU) or Emergency Department (ED) were included. Patients with cystic fibrosis were excluded. The compliance in terms of dosage, duration of treatment and indication was assessed.

Résultats / Results :
A total of 149 patients (median age 10 months, 66 males) receives aminoglycosides (33 amikacin and 116 gentamicin) during their stay, including 36 (24%) in PICU.
In patients admitted in PICU, the administered dose of amikacin and gentamicin were 15.9 mg/kg/day and 4.1 mg/kg, respectively, for a mean duration of two days. Underdosing was found in a total of 8 patients (22% of patients in PICU). Ten patients (28%) presented a septic shock but peak serum concentrations were never dosed.
Regarding patients admitted in ED, the main indication was pyelonephritis.
Monotherapy was never prescribed. No patient experienced nephrotoxicity in our study.
Overall, 77 prescriptions (48%) were considered as non appropriate according to the French recommendations. The main reason for misuse was the indication (n=60, 78%), followed by the underdosing.

Discussion / Discussion :


Conclusion / Conclusion :
The most of aminoglycosides prescriptions did not follow the French recommendations in our study. Despite some studies suggest a higher dose or a use in monotherapy, such practices were not widespread.
 

Blood exchange transfusion in severe pertussis: mortality risk factors

Orateur(s) :   Ahmed AYARI (Tunis, TUNISIE) 

Auteur(s) :  Rim OUERFELLI (Tunis)   Ahmed HAJJI (Tunis, TUNISIE)   Shatila HADJ HASSINE (Tunis, CANADA)   Assaad LOUATI (Tunis, TUNISIE)   Asma BOUZIRI (Tunis)   Khaled MENIF (Tunis)   Aïda BORGI (Tunis)   Nejla BEN JABALLAH (Tunis, TUNISIE)  

14h17 - 14h24
Durée de la présentation : 4 min
Durée de la discussion : 3 min


Abstract : 
Blood exchange transfusion in severe pertussis: mortality risk factors

Introduction / Rationale :
Severe Bordetella Pertussis infection is associated with a poor outcome in young infants. Recent data have suggested that blood exchange transfusion (BET) may be helpful for children with pertussis and leucocytosis.
We aimed to identify risk factors for mortality in patients with severe pertussis who have had BET.

Méthodes / Patients and Methods :
We collected over a period of 6 years (2013-2018) demographic and clinical data of children hospitalized in the paediatric intensive care unit for severe pertussis and undergone BET.

Résultats / Results :
Twenty-six infants were admitted (sex ratio 1.3, mean age: 49 days (± 23)). Of these patients, 11.5% were former premature babies and 50% were hypotrophic. At admission the mean respiratory rate was 61 c.p.m (± 17). The average heart rate was 197 b.p.m (± 27). The mean white blood cell count was 80369 / mm3 (± 28000), the mean lymphocyte count was 36160 / mm3 and 63% of our patients had pulmonary hypertension (PH). All patients were intubated ventilated and 61.5% have had a haemodynamic support. All our patients have had a BET. Fifty percent of the patients died. Mortality risk factors were: white blood cell count at admission (p = 0.02), PH (p = 0.002), and the use of norepinephrine (p = 0.02).

Discussion / Discussion :


Conclusion / Conclusion :
Identifying risk factors might allow for implementation of more rapid intervention
 

Pneumocystis Pneumonia in a Pediatric Intensive Care Unit: A retrospective study from 2006 to 2019

Orateur(s) :   Arielle MARONI (Paris) 

Auteur(s) :  Stéphane DAUGER (Paris)   Camille DOLLAT (Paris)   Jérôme NAUDIN (Paris)   Anna DEHO (Paris)   Géraldine PONCELET (Paris)   Michaël LEVY (Paris)   Fleur LE BOURGEOIS (Paris)   Guillaume GESLAIN (Paris)   Maryline CHOMTON (Paris)  

14h24 - 14h31
Durée de la présentation : 4 min
Durée de la discussion : 3 min


Abstract : 
Pneumocystis Pneumonia in a Pediatric Intensive Care Unit: A retrospective study from 2006 to 2019

Introduction / Rationale :
Pneumocystis jirovecii is a ubiquitous fungus, which causes severe pneumonia in immunocompromised children and required frequent admission in Pediactric Intensive Care Unit (PICU). Data on their management are poor in pediatric literature. The aim of our study is to describe the clinical characteristics and the management of Pneumocystis jirovecii Pneumonia (PJP) in our PICU.

Méthodes / Patients and Methods :
This retrospective observational study included children aged less than 18 years old who were admitted to the PICU and with a discharge diagnosis of PJP between 2006 and 2019. Age, underlying diseases, clinical signs, co-infections, supportive care, treatment response and clinical course were collected.

Résultats / Results :
Nineteen children, aged from 2 months to 16 years, were included and all presented acute respiratory failure rapidly progressing to a severe acute respiratory distress syndrome (ARDS) for 14 patients (74%). Underlying disease was known for 6 patients and PJP revealed immunodeficiency state for 13 patients: 10 cases of severe combined immunodeficiency (SCID) and 3 cases of mother-to-child transmission of HIV. Median time to start trimethoprim-sulfamethoxazole was 2 days (min: 0 - max: 25) after PICU admission. Until November 2012, diagnosis performed on broncho-alveolar lavage fluid; thereafter we used polymerase chain reaction (PCR) on nasopharyngeal or tracheal aspirate. Fourteen patients (74%) were intubated at day 1 post admission (min: 0 – max: 13) for a median duration of 9 days (min: 1 – max: 27). Among the 5 patients who were not intubated, 4 needed non-invasive ventilation. Adjuvant therapeutic steroids were added for 12 patients (63%) at 4.5 days (min: 0 – max: 25). Viral co-infections were frequent: 9 patients (47%) presented CMV blood co-infection and 8 patients (42%) presented viral respiratory co-infection (Rhinovirus, RSV and CMV). Three patients (16%) died: 2 deaths were caused by refractory hypoxemia related to PJP (both suffered from SCID), the third patient died from broncho-pulmonary dysplasia after recovery from PJP. Among the 16 survivors, 13 (81%) required supplementary oxygen therapy at the PICU discharge. Median length of stay in PICU was 14 days (min: 1 – max: 47).

Discussion / Discussion :


Conclusion / Conclusion :
PJP is responsible of life-threatening ARDS. Mechanical ventilation is required in most cases. Now, diagnosis is preferentially achieved by PCR. Viral co-infections would be systematically researched and treated. PJP is responsible of prolonged hospitalizations and supplementary oxygen therapies after PICU stay.
 

Prevalence of Staphylococcus aureus health care-associated infections among carriers and associated risk factors in a pediatric intensive care unit

Orateur(s) :   Perrine SEE (Paris) 

Auteur(s) :  Stéphane BONACORSI (Paris)   Jérôme NAUDIN (Paris)   Anna DEHO (Paris)   Géraldine PONCELET (Paris)   Catherine DOIT (Paris)   Fleur LE BOURGEOIS (Paris)   Maryline CHOMTON (Paris)   Stéphane DAUGER (Paris)   Michaël LEVY (Paris)  

14h31 - 14h38
Durée de la présentation : 4 min
Durée de la discussion : 3 min


Abstract : 
Prevalence of Staphylococcus aureus health care-associated infections among carriers and associated risk factors in a pediatric intensive care unit

Introduction / Rationale :
20 to 30% of the paediatric population is colonized with nasal Staphylococcus aureus (SA) and this germ is currently one of the leading causes of health care-associated infections (HCAI) in neonatal and paediatric intensive care units (PICU). It is known that the carriage of SA increases the risk of HCAI caused by SA but there is a lack of data regarding the incidence of HCAI in colonized patients and the associated risk factors.

Méthodes / Patients and Methods :
We performed a retrospective single-center descriptive study including all patients hospitalized in Robert-Debré University Hospital PICU and colonized with SA between the 1st of January 2011 and the 31st of December 2013.
Data were collected using the microbiology department's prospective database, hospital records, and biological results reporting software.
The results of the descriptive analysis were expressed as numbers and percentages for qualitative variables and as mean and standard deviation for quantitative variables. Two-tailed Fisher’s exact test for quantitative variables and Chi-square test for qualitative variable were used. Risk of infection was modeled using a multivariate logistical regression analysis.

Résultats / Results :
Among the 2383 patients hospitalized during the studied period, 573 patients were colonized with SA. Among them, 20 patients developed 21 episodes of HCAI caused by SA with an incidence of 3.7%. These HCAI were mainly respiratory infections (67%) followed by osteoarticular infections (9%), bacteremia (9%) and skin infections (9%).
Patients with an HCAI caused by SA had a significantly longer stay duration and a higher mortality rate than the rest of the population.
Multivariate analysis showed that antibiotic therapy in the 2 months prior to the hospitalization and hyponatremia during the hospitalization were significantly associated with the occurrence of HCAI caused by SA. On the other hand, an antibiotic therapy performed for another infection during the stay appears to be a protective factor.

Discussion / Discussion :


Conclusion / Conclusion :
SA infection occurs in 3.7% of colonized patients and has a significant impact on their length of stay and their mortality. Our results suggest that previous antibiotic therapy in the last 2 months before the hospitalizations, as well as the occurrence of hyponatremia during the stay represent significant risk factors for developing HCAI.
 

Acinetobacter baumannii nosocomial infections in pediatric intensive care unit at Casablanca Ibn Rochd Hospital

Orateur(s) :   Samira KALOUCH (Casablanca, MAROC) 

Auteur(s) :  Khalid YAQINI (Casablanca, MAROC)   Wissal AISSAOUI (Casablanca)   Abdelaziz CHLILEK (Casablanca)  

14h38 - 14h45
Durée de la présentation : 4 min
Durée de la discussion : 3 min


Abstract : 
Acinetobacter baumannii nosocomial infections in pediatric intensive care unit at Casablanca Ibn Rochd Hospital

Introduction / Rationale :
Acinetobacter baumannii is a ubiquitous pathogen , resistant to desiccation ,responsible for care associated infections ,especially in intensive care.

Méthodes / Patients and Methods :
Our work is a retrospective descriptive study over a period of 3 years (December 2015,December 2017) on patients who presented a nosocomial infection with acinetobacter baumannii during their hospitalization in pediatric intensive care unit.

Résultats / Results :
In our study the majority of patients were ventilated/intubated (92%),with bladder catheter port (40.30%). While (92.90%)of the patients were tracheotomized.
Infectious site was mainly : pulmonary (82%),associated with bacteremia (18%) while (16%)was due to infections in the catheter.
The average time of onset of infection was 10 days with extremes of 2 days to 67 days.
We noted a very important resistance to the majority of antibiotics: gentamicin 99% ,ceftazidime 97% ,ciprofloxacin 93%, imipenems 85% and amikacin 77%. While 19% of the strains were sensitive to rifampicin. Resistance to tigecycline and colimycin was 1%.
There is high mortality rate of 63% with male predominance.

Discussion / Discussion :


Conclusion / Conclusion :
It appears from our results that nosocomial infections with acinetobacter baumannii and resistance of this germ to antibiotics are worring.The judicious use of antibiotics ,hand washing and the use of sterile equipment are essential to reduce the incidence of nosocomial infection with acinetobacter baumannii. Epidemiological surveillance of infections in intensive care and adherence to hygiene measures are priorities to be included in any program of nosocomial infection control and prevention.
 

Postoperative treatment with vancomycin in children with liver or combined liver-kidney transplantation

Orateur(s) :   Mehdi OUALHA (Paris) 

Auteur(s) :  Hélène YAGER (Paris)   Delphine CALLOT (Paris)   Mathieu GENUINI (Paris)   Julie TOUBIANA (Paris)   Agathe BÉRANGER (Paris)   Florence LACAILLE (Paris)   Romain BERTHAUD (Paris)   Christophe CHARDOT (Paris)   Carole HENNEQUIN (Paris)   Anais BRASSIER (Paris)   Sihem BENABOUD (Paris)   Sylvain RENOLLEAU (Paris)  

14h45 - 14h52
Durée de la présentation : 4 min
Durée de la discussion : 3 min


Abstract : 
Postoperative treatment with vancomycin in children with liver or combined liver-kidney transplantation

Introduction / Rationale :
Children with liver or combined liver-kidney transplantation may receive vancomycin during the early phase of postoperative stage for suspected infections related to gram positive agents. To describe the use of vancomycin and associated exposure and nephrotoxicity

Méthodes / Patients and Methods :
This single center and retrospective study was conducted in a pediatric intensive and intermediate care units at Necker hospital from January 2015 to June 2019. We included all children (< 18 years old) with liver or combined liver-kidney transplantation who received continuous vancomycin infusion during the postoperative stage for at least 24 hours. Nephrotoxicity related to vancomycin was assessed using the pRiFLE classification and by the expert advice of the local pharmacovigilance unit. Supratherapeutic exposure to vancomycin was defined when the vancomycin plasmatic concentration at steady state was >30 mg/L. Catheter related infection was defined using the IDSA recommendations. A posteriori analysis of appropriateness of vancomycin use was assessed by an infectious disease expert. The vancomycin was therefore considered as justified or not and appropriate or not. Occurrence of nephrotoxicity and supratherapeutic exposure in this study group was compared to critically ill children control group

Résultats / Results :
Thirty one children receiving 43 vancomycin lines of treatment whose 13 (26 %) observed a risk of acute kidney injury (AKI) (n = 8) and an AKI (n = 5) during the vancomycin treatment period were included. There was a trend to inversed relationship between plasmatic concentrations of vancomycin and estimated creatinine clearance (r²=0.2019). Seven patients observed a nephrotoxicity related to vancomycin, they had a higher plasmatic concentration of vancomycin (p = 0.0009). Seven patients (22 %) had a supratherapeutic exposure to vancomycin. Nephrotoxicity and supratherapeutic exposure were higher in children with or combined liver-kidney transplantation than in comparative critically ill children group. We found 1 blood stream infection due to the central catheter and 7 blood stream infections probably due to the central catheter. One hundred thirty-five bacteria were identified of which 108 (80 %) were Staphylococcus coagulase negative. Nineteen (44 %) lines of vancomycin were appropriate and 31 (72 %) were justified

Discussion / Discussion :


Conclusion / Conclusion :
Vancomycin could have been avoided in one third of children with liver or combined liver-kidney transplantation during the early phase of postoperative stage. Vancomycin is associated with a risk of both nephrotoxicity and supratherapeuric exposure. Vancomycin should be used with caution, appropriate indications and dosing in this vulnerable population
 

Early bacterial infections after pediatric liver transplantation in the era of multiresistant bugs: a 9-year retrospective experience

Orateur(s) :   Agathe BÉRANGER (Paris) 

Auteur(s) :  Carmen CAPITO (Paris)   Florence LACAILLE (Paris)   Agnès FERRONI (Paris)   Naïm BOUAZZA (Paris)   Muriel GIRARD (Paris)   Mehdi OUALHA (Paris)   Sylvain RENOLLEAU (Paris)   Dominique DEBRAY (Paris)   Christophe CHARDOT (Paris)   Pierre FRANGE (Paris)   Florence MOULIN (Paris)  

14h52 - 14h59
Durée de la présentation : 4 min
Durée de la discussion : 3 min


Abstract : 
Early bacterial infections after pediatric liver transplantation in the era of multiresistant bugs: a 9-year retrospective experience

Introduction / Rationale :
Early bacterial infection is a major and severe complication occurring within the first month after pediatric liver transplantation (LT). The rise of antimicrobial resistance, especially extended-spectrum beta lactamase producing Enterobacteriaceae (ESBL-PE), is henceforth a concern for these patients. This study aimed to assess the epidemiology of early bacterial infections, including those caused by multidrug-resistant (MDR) pathogens, and to identify the risk factors for infection.

Méthodes / Patients and Methods :
We conducted a monocentric retrospective study including 142 consecutive LTs in 137 children from 2009 to 2017.

Résultats / Results :
Ninety-three bacterial infections occurred after 67 (47%) LTs. Among the 82 isolated pathogens, the most common were Klebsiella pneumoniae (n=19, 23%) and coagulase negative Staphylococcus (n=16, 20%). Independent risk factors for early bacterial infection were a low weight (OR=0.96, 95%CI (0.92-0.99), p=0.03) and the presence of a prosthetic mesh (OR=2.4, 95%CI (1.1-5.4), p=0.046). Sixty-one (45%) children carried MDR bacteria and 16 infections were caused by MDR pathogens, especially ESBL producing K. pneumoniae. ESBL-PE carriage was associated with ESBL-PE infection (OR=4.5, 95%CI (1.4-17.4), p=0.02). Four children died from an early bacterial infection, three of which were caused by ESBL producing K. pneumoniae.

Discussion / Discussion :


Conclusion / Conclusion :
Early bacterial infection is a known complication after pediatric LT, with a shift toward a predominance of Gram-negative bacteria infections. The most important risk factors were low weight and presence of a prosthetic mesh. Stool ESBL-PE carriage was highly prevalent and associated with ESBL-PE infection. An adapted antimicrobial prophylaxis and personalized antibiotherapy are mandatory to reduce the infection prevalence and mortality.
 

B-lactams in critically ill children with renal failure and continuous renal replacement therapy: dosing and exposure

Orateur(s) :   Mehdi OUALHA (Paris) 

Auteur(s) :  Benjamin PRIM (Paris)   Déborah HIRT (Paris)   Saoussen KRID (Paris)   Inès GANA (Paris)   Fabrice LESAGE (Paris)   Romain BERTHAUD (Paris)   Sihem BENABOUD (Paris)   Jean-marc TRÉLUYER (Paris)   Sylvain RENOLLEAU (Paris)  

14h59 - 15h06
Durée de la présentation : 4 min
Durée de la discussion : 3 min


Abstract : 
B-lactams in critically ill children with renal failure and continuous renal replacement therapy: dosing and exposure

Introduction / Rationale :
Renal failure (RF) occurs in 1/3 of critically ill children with sometimes need of continuous renal replacement therapy (CRRT). In sepsis, appropriate antibiotic plasmatic concentrations are associated with better clinical outcomes. This study aims to describe the dosing of β-lactams and plasmatic concentrations in critically ill children with RF and/or CRRT and to identify clinical and biological variables associated with β-lactams sub optimal exposure.

Méthodes / Patients and Methods :
We included all critically ill children with RF and/or CRRT receiving β-lactams from January 2016 to December 2017

Résultats / Results :
39 critically ill children were included, 24 and 22 during RF and CRRT period, respectively. Initial dosing adjustment was done in 5 children (18 %) with RF and in 9 children (32 %) under CRRT. According to the guidelines, appropriate adjustments were observed in 10 (37%) children with RF. At 1st sample, 8 patients (32 %) with RF had insufficient β-lactams concentration whereas 6 patients (24 %) had supra therapeutic exposure. 9 children with RF observed at least one insufficient β-lactams concentration during the treatment. For children under CRRT, 13 (56 %) had insufficient β-lactams concentration and one had supra therapeutic exposure. 17 children (73 %) under CRRT observed at least one insufficient β-lactams concentration during the treatment. High dialysate flow rate, 113 ml/kg/h (77-174) was associated with insufficient β-lactams concentrations (p = 0.018).

Discussion / Discussion :


Conclusion / Conclusion :
More than half of critically ill children with renal failure or CRRT had inadequate β-lactams concentration. Optimizing dosing regimen of β-lactams and therapeutic drug monitoring of concentrations are mandatory in this population.