ABSTRACT
From November 2009 to October 2012, implementation of guidelines, unlabeled by the French Agency of Health Products, changed the categories of antibiotics prescribed for acute respiratory tract infections in 7 pediatric emergency departments. During the study, 36,413 acute respiratory tract infections-related antibiotic prescriptions were prescribed. Amoxicillin prescriptions rose from 30.0% to 84.7%, while amoxicillin-clavulanate and cefpodoxime prescriptions decreased to 10.2% and 2.5%, respectively.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Drug Prescriptions/statistics & numerical data , Emergency Service, Hospital/statistics & numerical data , Respiratory Tract Infections/drug therapy , Amoxicillin/administration & dosage , Amoxicillin/therapeutic use , Amoxicillin-Potassium Clavulanate Combination/administration & dosage , Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Ceftizoxime/administration & dosage , Ceftizoxime/analogs & derivatives , Ceftizoxime/therapeutic use , Child, Preschool , Drug Resistance, Bacterial , France , Humans , Infant , Pediatrics , Practice Guidelines as Topic , Prospective Studies , Respiratory Tract Infections/epidemiology , CefpodoximeABSTRACT
BACKGROUND: Transfusion is a cornerstone of the management of sickle cell disease but carries a high risk of hemolytic transfusion reaction, probably because of differences in erythrocyte antigens between blood donors of European descent and patients of African descent. Patients may experience hemolytic transfusion reactions that are delayed by from a few days to two weeks and manifest as acute hemolysis (hemoglobinuria, jaundice, and pallor), symptoms suggesting severe vaso-occlusive crisis (pain, fever, and acute chest syndrome), and profound anemia, often with reticulocytopenia. This case-series study aims to describe the main characteristics of this syndrome, to discuss its pathophysiology, and to propose a management strategy. DESIGN AND METHODS: We identified 8 pediatric cases of delayed hemolytic transfusion reactions between 2006 and 2009 in the database of the Necker Hospital, France. All patients had received cross-matched red cell units compatible in the ABO, RH, and KEL systems. We reviewed the medical charts in the computerized blood transfusion databases. All patients were admitted to the intensive care unit. We progressively adopted the following strategy: intravenous immunoglobulins, and darbopoietin alpha when the reticulocyte count was below 150×10(9)/L, without further blood transfusion during the acute episode unless absolutely necessary. RESULTS: The median time between the transfusion and the diagnosis of delayed hemolytic transfusion reaction was six days. All patients had severe bone pain; all but one had a high-grade fever. Five patients had hemoglobin levels less than than 4 g/dL and 3 had reticulocytopenia. In 5 patients, no new antibody was found; one patient had weakly reactive antibodies. Only 2 patients had new allo-antibodies possibly responsible for the delayed hemolytic reaction. CONCLUSIONS: The initial symptoms of delayed hemolytic transfusion reaction were complex and mimicked other complications of sickle cell disease. In most of our cases, no new antibody was identified, which underlines the complexity of the pathophysiology of this syndrome.
Subject(s)
Anemia, Sickle Cell/complications , Anemia, Sickle Cell/therapy , Hemolysis/immunology , Transfusion Reaction , Adolescent , Anemia, Sickle Cell/blood , Anemia, Sickle Cell/immunology , Child , Child, Preschool , Female , Humans , Immunoglobulins, Intravenous , Isoantibodies/blood , Isoantibodies/immunology , Male , Rh-Hr Blood-Group System/immunology , Treatment OutcomeABSTRACT
OBJECTIVE: Meningococcal disease due to Neisseria meningitidis of serogroup W135 (N. meningitidis W135) is increasing in France. Clinical and outcome data concerning these infections in children are scarce. PATIENTS: We report 5 cases of children hospitalised in our unit between June 2000 and December 2002 for N. meningitidis W135 infection. CASE REPORTS: Among these 5 children aged 19 months to 11 years, 3 presented with a primary meningitis and 4 with primary or secondary extra-meningeal involvement, articular in 3 cases, pericardial in 2 cases and ocular in one case. The outcome was favourable without after effects in 4 cases, marked by a resistant prolonged post-meningococcal inflammatory syndrome. COMMENTS: Extra-meningeal septic and/or non septic complications are frequent and a prolonged post meningococcal inflammatory syndrome is reported. In N. meningitidis W135 infections a careful clinical evaluation of potential extra-meningeal complications and a long term follow up of children are needed.
Subject(s)
Meningococcal Infections/epidemiology , Meningococcal Infections/microbiology , Neisseria meningitidis, Serogroup W-135 , Aftercare , Arthritis, Infectious/microbiology , Child , Child, Preschool , DNA, Bacterial/analysis , DNA, Bacterial/genetics , Drug Resistance, Bacterial , France/epidemiology , Genotype , Hospitalization/statistics & numerical data , Humans , Infant , Inflammation , Meningococcal Infections/diagnosis , Meningococcal Infections/therapy , Microbial Sensitivity Tests , Needs Assessment , Neisseria meningitidis, Serogroup W-135/genetics , Pericarditis/microbiology , Polymerase Chain Reaction , Population Surveillance , Serotyping , Syndrome , Treatment Outcome , Uveitis/microbiologyABSTRACT
We describe 5 pediatric cases of Neisseria meningitidis serogroup W135 infection. Infectious and/or reactive extrameningeal involvement was frequent. One patient had a persistent postmeningococcal inflammatory syndrome. Four of 5 isolates belonged to the clonal complex 37. The important risk of extrameningeal complications must be borne in mind when treating children with N. meningitidis W135 infection.
