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Madhi F, Panetta L, De Pontual L, Biscardi S, Remus N, Gillet Y, Gajdos V, Ros B, Angoulvant F, Dutron S, Cohen R. Antimicrobial treatment of lower respiratory tract infections in children. Infect Dis Now 2023; 53:104782. [PMID: 37714411 DOI: 10.1016/j.idnow.2023.104782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 09/17/2023]
Abstract
Lower respiratory tract infections (LRTI) encompass a wide range of clinical syndromes, prominently including bronchiolitis, bronchitis and pneumonia. LRTIs are the second leading cause of antibiotic prescriptions. The vast majority of these infections are due to (or triggered by) viruses and are self-limited diseases. Pneumonia in children is responsible for significant morbidity and mortality worldwide. For clinicians, one of the main difficulties consists in diagnosing pneumonia in febrile children with (or without) cough. The diagnosis is given on the basis of anamnesis, clinical examination and (if necessary) complementary examinations, with chest X-ray or thoracic ultrasound; biological markers are particularly important. Over recent years, since the implementation of PCV13, the bacterial epidemiology of pneumonia and empyema has evolved; involvement in these diseases of pneumococcus has been reduced, and resistance to penicillin has lessened - and remained extremely low. In 2021, according to the National Pneumococcal Reference Center, only 6% of the strains isolated from blood cultures in children are resistant to amoxicillin. The therapeutic choices proposed in this article are in full compliance with the previously published official French recommendations.
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Affiliation(s)
- Fouad Madhi
- Université Paris Est, IMRB-GRC GEMINI, 94000 Créteil, France; Pediatric Infectious Pathology Group of the French Pediatric Society (GPIP), France; Department of General Pediatrics, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Luc Panetta
- Pediatric Infectious Pathology Group of the French Pediatric Society (GPIP), France; Pediatric Emergency Room, HFME Lyon, France
| | - Loic De Pontual
- Pediatric Infectious Pathology Group of the French Pediatric Society (GPIP), France; Department of General Pediatrics, Jean Verdier Hospital, Bondy, France
| | - Sandra Biscardi
- Université Paris Est, IMRB-GRC GEMINI, 94000 Créteil, France; Pediatric Infectious Pathology Group of the French Pediatric Society (GPIP), France; Pediatric Emergency Room, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Natacha Remus
- Pediatric Infectious Pathology Group of the French Pediatric Society (GPIP), France; Department of General Pediatrics, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Yves Gillet
- Pediatric Infectious Pathology Group of the French Pediatric Society (GPIP), France; Pediatric Emergency Room, HFME Lyon, France
| | - Vincent Gajdos
- Pediatric Infectious Pathology Group of the French Pediatric Society (GPIP), France; Department of Pediatrics, Antoine Béclère Hospital, Clamart, France
| | - Barbara Ros
- Pediatric Infectious Pathology Group of the French Pediatric Society (GPIP), France; Neonatal and Pediatric Intensive Care Unit, University Hospital of Bordeaux, Bordeaux, France
| | - François Angoulvant
- Pediatric Infectious Pathology Group of the French Pediatric Society (GPIP), France; Department of General Pediatrics, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Sarah Dutron
- Pediatric Infectious Pathology Group of the French Pediatric Society (GPIP), France; Department of Pediatrics, Centre Hospitalier de Montpellier, Montpellier, France
| | - Robert Cohen
- Université Paris Est, IMRB-GRC GEMINI, 94000 Créteil, France; Pediatric Infectious Pathology Group of the French Pediatric Society (GPIP), France; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Créteil.
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Vaezipour N, Fritschi N, Brasier N, Bélard S, Domínguez J, Tebruegge M, Portevin D, Ritz N. Towards Accurate Point-of-Care Tests for Tuberculosis in Children. Pathogens 2022; 11:pathogens11030327. [PMID: 35335651 PMCID: PMC8949489 DOI: 10.3390/pathogens11030327] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 12/20/2022] Open
Abstract
In childhood tuberculosis (TB), with an estimated 69% of missed cases in children under 5 years of age, the case detection gap is larger than in other age groups, mainly due to its paucibacillary nature and children’s difficulties in delivering sputum specimens. Accurate and accessible point-of-care tests (POCTs) are needed to detect TB disease in children and, in turn, reduce TB-related morbidity and mortality in this vulnerable population. In recent years, several POCTs for TB have been developed. These include new tools to improve the detection of TB in respiratory and gastric samples, such as molecular detection of Mycobacterium tuberculosis using loop-mediated isothermal amplification (LAMP) and portable polymerase chain reaction (PCR)-based GeneXpert. In addition, the urine-based detection of lipoarabinomannan (LAM), as well as imaging modalities through point-of-care ultrasonography (POCUS), are currently the POCTs in use. Further to this, artificial intelligence-based interpretation of ultrasound imaging and radiography is now integrated into computer-aided detection products. In the future, portable radiography may become more widely available, and robotics-supported ultrasound imaging is currently being trialed. Finally, novel blood-based tests evaluating the immune response using “omic-“techniques are underway. This approach, including transcriptomics, metabolomic, proteomics, lipidomics and genomics, is still distant from being translated into POCT formats, but the digital development may rapidly enhance innovation in this field. Despite these significant advances, TB-POCT development and implementation remains challenged by the lack of standard ways to access non-sputum-based samples, the need to differentiate TB infection from disease and to gain acceptance for novel testing strategies specific to the conditions and settings of use.
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Affiliation(s)
- Nina Vaezipour
- Mycobacterial and Migrant Health Research Group, University Children’s Hospital Basel, Department for Clinical Research, University of Basel, 4056 Basel, Switzerland; (N.V.); (N.F.)
- Infectious Disease and Vaccinology Unit, University Children’s Hospital Basel, University of Basel, 4056 Basel, Switzerland
| | - Nora Fritschi
- Mycobacterial and Migrant Health Research Group, University Children’s Hospital Basel, Department for Clinical Research, University of Basel, 4056 Basel, Switzerland; (N.V.); (N.F.)
| | - Noé Brasier
- Department of Health Sciences and Technology, Institute for Translational Medicine, ETH Zurich, 8093 Zurich, Switzerland;
- Department of Digitalization & ICT, University Hospital Basel, 4031 Basel, Switzerland
| | - Sabine Bélard
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany;
- Institute of Tropical Medicine and International Health, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - José Domínguez
- Institute for Health Science Research Germans Trias i Pujol. CIBER Enfermedades Respiratorias, Universitat Autònoma de Barcelona, 08916 Barcelona, Spain;
| | - Marc Tebruegge
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London WCN1 1EH, UK;
- Department of Pediatrics, The Royal Children’s Hospital Melbourne, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Damien Portevin
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland;
- University of Basel, 4001 Basel, Switzerland
| | - Nicole Ritz
- Mycobacterial and Migrant Health Research Group, University Children’s Hospital Basel, Department for Clinical Research, University of Basel, 4056 Basel, Switzerland; (N.V.); (N.F.)
- Department of Pediatrics, The Royal Children’s Hospital Melbourne, The University of Melbourne, Parkville, VIC 3052, Australia
- Department of Paediatrics and Paediatric Infectious Diseases, Children’s Hospital, Lucerne Cantonal Hospital, 6000 Lucerne, Switzerland
- Correspondence: ; Tel.: +41-61-704-1212
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Hubert G, Launay E, Feildel Fournial C, Chauvire-Drouard A, Lorton F, Tavernier E, Giraudeau B, Gras Le Guen C. Assessment of the impact of a new sequential approach to antimicrobial use in young febrile children in the emergency department (DIAFEVERCHILD): a French prospective multicentric controlled, open, cluster-randomised, parallel-group study protocol. BMJ Open 2020; 10:e034828. [PMID: 32792425 PMCID: PMC7430445 DOI: 10.1136/bmjopen-2019-034828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Fever is one of the most common reasons for consultation in the paediatric emergency department (ED). Because of fear of bacterial infection in parents and caregivers, clinicians often overprescribe laboratory tests and empirical antibiotic treatment. The aims of this study are to demonstrate that using a procalcitonin (PCT) rapid test-based prediction rule (1) would not be inferior to usual practice in terms of morbidity and mortality (non-inferiority objective) and (2) would result in a significant reduction in antibiotic use (superiority objective). METHODS AND ANALYSIS This prospective multicentric cluster-randomised study aims to include 7245 febrile children aged 6 days to 3 years with a diagnosis of fever without source in 26 participating EDs in France and Switzerland during a 24-month period. During first period, all children will receive usual care. In a second period, a point-of-care PCT-based algorithm will be used in half of the clusters. The primary endpoints collected on day 15 after ED consultation will be a composite outcome of death or intensive care unit admission for any reason, disease-specific complications, diagnosis of bacterial infection after discharge from the ED for the non-inferiority objective and proportion of children with antibiotic treatment administered for the superiority objective. The endpoints will be compared between the two groups (experimental and control) by using a mixed logistic regression model adjusted on clustering of participants within centres and period within centres. DISCUSSION If the algorithm is validated, a new strategy will be discussed with medical societies to safely manage fever in young children without the need for invasive procedures for microbiological testing or empirical antibiotics. ETHICS AND DISSEMINATION This study was submitted to an independent ethics committee on 17 May 2018 (no. 2018-A00252-53). Results will be submitted to international peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER NCT03607162; Pre-results.
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Affiliation(s)
- Gaelle Hubert
- Paediatrics Emergency Department, CHU Nantes, Nantes, France
| | - Elise Launay
- General Paediatrics Department, CHU Nantes, Nantes, France
- Clinical Research Department, Clinical Investigation Center Femme Enfant Adolescent-1413 INSERM, CHU Nantes, Nantes, France
| | | | - Anne Chauvire-Drouard
- Clinical Research Department, Clinical Investigation Center Femme Enfant Adolescent-1413 INSERM, CHU Nantes, Nantes, France
| | - Fleur Lorton
- Paediatrics Emergency Department, CHU Nantes, Nantes, France
- Clinical Research Department, Clinical Investigation Center Femme Enfant Adolescent-1413 INSERM, CHU Nantes, Nantes, France
| | - Elsa Tavernier
- Biostatistics Department, Clinical Investigation Center-1415 INSERM, CHU Tours, Tours, France
| | - Bruno Giraudeau
- Biostatistics Department, Clinical Investigation Center-1415 INSERM, CHU Tours, Tours, France
| | - Christele Gras Le Guen
- Paediatrics Emergency Department, CHU Nantes, Nantes, France
- General Paediatrics Department, CHU Nantes, Nantes, France
- Clinical Research Department, Clinical Investigation Center Femme Enfant Adolescent-1413 INSERM, CHU Nantes, Nantes, France
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Gkika E, Psaroulaki A, Tselentis Y, Angelakis E, Kouikoglou VS. Can point-of-care testing shorten hospitalization length of stay? An exploratory investigation of infectious agents using regression modelling. Health Informatics J 2018; 25:1606-1617. [PMID: 30179068 DOI: 10.1177/1460458218796612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This retrospective study investigates the potential benefits from the introduction of point-of-care tests for rapid diagnosis of infectious diseases. We analysed a sample of 441 hospitalized patients who had received a final diagnosis related to 18 pathogenic agents. These pathogens were mostly detected by standard tests but were also detectable by point-of-care testing. The length of hospital stay was partitioned into pre- and post-laboratory diagnosis stages. Regression analysis and elementary queueing theory were applied to estimate the impact of quick diagnosis on the mean length of stay and the utilization of healthcare resources. The analysis suggests that eliminating the pre-diagnosis times through point-of-care testing could shorten the mean length of hospital stay for infectious diseases by up to 34 per cent and result in an equal reduction in bed occupancy and other resources. Regression and other more sophisticated models can aid the financing decision-making of pilot point-of-care laboratories in healthcare systems.
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Electronic clinical decision algorithms for the integrated primary care management of febrile children in low-resource settings: review of existing tools. Clin Microbiol Infect 2018; 24:845-855. [PMID: 29684634 DOI: 10.1016/j.cmi.2018.04.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 04/10/2018] [Accepted: 04/16/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND The lack of effective, integrated diagnostic tools poses a major challenge to the primary care management of febrile childhood illnesses. These limitations are especially evident in low-resource settings and are often inappropriately compensated by antimicrobial overprescription. Electronic clinical decision algorithms (eCDAs) have the potential to close these gaps by guiding antibiotic use and better identifying serious disease. AIMS This narrative review summarizes existing eCDAs, to provide an overview of their degree of validation and to identify gaps in current knowledge and prospects for future innovation. SOURCES Structured literature review in PubMed and Embase complemented by Google search and contact with developers. CONTENT Six integrated eCDAs were identified: three (eIMCI, REC and Bangladesh digital IMCI) based on Integrated Management of Childhood Illnesses (IMCI); four (SL electronic iCCM, MEDSINC, electronic iCCM and D-Tree electronic iCCM) on Integrated Community Case Management (iCCM); two (ALMANACH, MSFeCARE) with a modified IMCI content; and one (ePOCT) that integrates novel content with biomarker testing. The types of publications and evaluation studies varied greatly: the content and evidence base were published for two (ALMANACH and ePOCT) and ALMANACH and ePOCT were validated in efficacy studies. Other types of evaluations, such as compliance and acceptability, were available for D-Tree electronic iCCM, eIMCI and ALMANACH. Several evaluations are still ongoing. Future prospects include conducting effectiveness and impact studies using data gathered through larger studies to adapt the medical content to local epidemiology, improving the software and sensors, and assessing factors that influence compliance and scale-up. IMPLICATIONS eCDAs are valuable tools that have the potential to improve management of febrile children in primary care and increase the rational use of diagnostics and antimicrobials. Next steps in the evidence pathway should be larger effectiveness and impact studies (including cost analysis) and continuous integration of clinically useful diagnostic and treatment innovations.
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