Infections bactériennes graves de l'enfant. Enquête des SMUR pédiatriques AP/HP de l'Île-de-France (de 1998 au 1 er quadrimestre 2001)

Abstract

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 pronostic (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.