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Poirault C, Hadchouel A, Roy C, Schmartz S, Gonsard A, Garcelon N, Delacourt C, Drummond D. Inflammatory rebound and postinfectious inflammatory response in children with pleural infection: A single-center retrospective study. Pediatr Pulmonol 2024. [PMID: 38206078 DOI: 10.1002/ppul.26859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/21/2023] [Accepted: 01/01/2024] [Indexed: 01/12/2024]
Abstract
INTRODUCTION As pleural inflammation plays a central role in pleural infection (PI), corticosteroids are increasingly being considered as a potential therapy. However, the timing of treatment and the identification of patients who might benefit most remain unresolved. The aim of this study was therefore to investigate the inflammatory trajectories of children with PI. METHODS This retrospective single-center study included children aged 3 months to 17 years and 11 months hospitalized for PI due to Streptococcus pyogenes, Streptococcus pneumonia, and Staphylococcus aureus over 10 years. An inflammatory rebound was defined biologically as a reincrease in C-reactive protein (CRP) of at least 50 mg/L after an initial decrease in CRP of at least 50 mg/L. RESULTS We included 53 cases of PI, including 16 due to S. pyogenes, 27 due to S. pneumonia, and 10 due to S. aureus. An inflammatory rebound occurred in 20 patients (38%) after a median of 4.5 (3-6) days. This inflammatory rebound occurred in 9 (56%) children with S. pyogenes, 8 (30%) children with S. pneumonia, and 3 (30%) children with S. aureus. Children with an inflammatory rebound also had a higher rate of persistent fever after Day 7 and a longer length of stay (p = .01 for both). CONCLUSION We postulate that the inflammatory rebound identified in nearly 40% of our patients corresponds to an early postinfectious inflammatory response, and thus that corticosteroids may be most beneficial for children with PI if administered early (between Days 2 and 5).
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Affiliation(s)
- Clément Poirault
- Department of Pediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP, Paris, France
| | - Alice Hadchouel
- Department of Pediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP, Paris, France
| | - Charlotte Roy
- Department of Pediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP, Paris, France
| | - Sophie Schmartz
- Department of Pediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP, Paris, France
| | - Apolline Gonsard
- Department of Pediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP, Paris, France
| | - Nicolas Garcelon
- Université Paris Cité, Paris, France
- Institut Imagine, Paris, France
- INSERM, Centre de Recherche des Cordeliers, UMR 1138 Equipe 22, Paris, France
| | - Christophe Delacourt
- Department of Pediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP, Paris, France
- Université Paris Cité, Paris, France
| | - David Drummond
- Department of Pediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP, Paris, France
- Université Paris Cité, Paris, France
- Inserm UMR 1138, HeKA team, Centre de Recherche des Cordeliers, Paris, France
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Abraham P, Marin G, Filleron A, Michon AL, Marchandin H, Godreuil S, Rodière M, Sarrabay G, Touitou I, Meslin P, Tournier C, Van de Perre P, Nagot N, Jeziorski E. Evaluation of post-infectious inflammatory reactions in a retrospective study of 3 common invasive bacterial infections in pediatrics. Medicine (Baltimore) 2022; 101:e30506. [PMID: 36197203 PMCID: PMC9509192 DOI: 10.1097/md.0000000000030506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Infectious diseases can result in unanticipated post-infectious inflammatory reactions (PIIR). Our aim was to explore PIIR in 3 frequent pediatric bacterial invasive infections in France by a retrospective monocentric study. We included children hospitalized between 2003 and 2012 for Streptococcus pneumoniae (SP), Neisseria meningitidis (NM), or Streptococcus pyogenes invasive infections. The PIIR had to have occurred between 3 and 15 days without fever despite an individually tailored antibiotic therapy. A descriptive analysis was carried out to determine PIIR risk factors. We included 189 patients, of whom 72, 79, and 38 exhibited invasive infections caused by S pyogenes, SP, and NM, respectively. The mean age was 44 months. PIIR were observed in 39 cases, occurring after a median of 8 days (5-12), with a median duration of 3 days (2-6). Fever, arthritis, and pleural effusion were observed in 87%, 28.2%, and 25.6%, respectively. In multivariate analysis, PIIR were associated with pleuropneumonia, hospitalization in an intensive care unit (ICU), and elevated C-reactive protein (CRP). PIIR were observed in 20% of children after SP, NM, or S pyogenes invasives infections. Their occurrence was associated with the initial severity but not the etiological microorganism. Further studies are warranted to confirm these findings.
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Affiliation(s)
| | - Gregory Marin
- Departement d’Information Medicale, CHU Montpellier, Montpellier, France
| | - Anne Filleron
- Department de pédiatrie, CHU Nîmes, Université de Montpellier, Nîmes, France
- IRMB, Université de Montpellier, INSERM, Montpellier, France
| | | | - Hélène Marchandin
- HydroSciences Montpellier, University of Montpellier, CNRS, IRD, Montpellier, France
- Laboratoire de microbiologie, CHU Nîmes, Nîmes, France
| | - Sylvain Godreuil
- Laboratoire de bactériologie, CHU Montpellier, Montpellier, France
- UMR MIVEGEC, Université de Montpellier, CNRS, IRD, Montpellier, France
| | - Michel Rodière
- Département urgences, post-urgences, CHU Montpellier, Montpellier, France
| | | | | | - Pauline Meslin
- Service de pédiatrie générale, CH Perpignan, Perpignan, France
| | - Carine Tournier
- Département urgences, post-urgences, CHU Montpellier, Montpellier, France
| | | | - Nicolas Nagot
- Departement d’Information Medicale, CHU Montpellier, Montpellier, France
- PCCEI, Univ Montpellier, Université de Antilles, Inserm, EFS, Montpellier, France
| | - Eric Jeziorski
- Département urgences, post-urgences, CHU Montpellier, Montpellier, France
- CeRéMAIA, CHU Montpellier, Montpellier, France
- PCCEI, Univ Montpellier, Université de Antilles, Inserm, EFS, Montpellier, France
- *Correspondence: Eric Jeziorski, Centre Hospitalier Universitaire Montpellier, Hôpital Arnaud de Villeneuve, 371, Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France (e-mail: )
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