[Antibioprophylaxis in pediatric surgery: how to harmonize practices?]. / Antibioprophylaxie chirurgicale : les grands principes, état des lieux et exemple d'harmonisation des pratiques.

Surgical antibiotic prophylaxis has demonstrated its effectiveness in reducing surgical site infections. Existing recommendations for adults are however subject to poor compliance. Surgical antibiotic representing a significant proportion of antibiotic prescriptions, it is then important to respect its general principles (narrow spectrum, short duration, choosing molecules different than the ones used in therapeutics, etc.) to limit its impact on the bacterial ecology. A brief survey of pediatric practices in five French university hospitals has allowed us to highlight some significant changes in terms of choice of molecule or duration. Through the experience of harmonizing practices at the University Hospital of Nantes, we showed that the development of national guidelines is a prerequisite to harmonize practices but must be accompanied by a multidisciplinary reflexion within each hospital in order to improve their acceptability and application.

[Antibioprophylaxis in pediatric orthopedic surgery]. / Antibioprophylaxie en chirurgie orthopédique pédiatrique.

The pediatric osteo-articular surgery has certain characteristics that justify specific recommendations (spine surgery, reconstruction after tumorectomy). The children with the higher risks of surgical site infection are children with comorbidities or undergoing prolonged surgery. Bacteria targeted by antibioprophylaxis are those of the skin flora, most particularly Staphylococcus aureus. Cefazolin is the antibiotic of choice for osteoarticular surgery. Detection and decontamination of Staphylococcus aureus can be discussed especially in centers with strong incidence of surgical site infection caused by MRSA. The adaptation of the antibioprophylaxis to the urinary flora of patients with neuromuscular disease can also be justified on a case before spine surgery.

[Neonatal surgical antibioprophylaxis: which target? which propositions?]. / Antibioprophylaxie en chirurgie néonatale : quelle est la cible ? quelles propositions ?

Neonatal surgical antibioprophylaxis must take into account the specificities of this life period, as immunological immaturity, microbiotal implantation and antibiotic treatment pharmacokinetics properties. Very few data are available, but it seems that coagulase negative Staphylococcus (CNS) is the most reported bacteria, in intestinal tract at the time of surgery as well as in surgical site infections. Usual vertical transmission bacteria as S. agalactiae or E. coli K1 are rarely documented. The antibioprophylaxis treatment must consider the age and the environmental context of the newborn; first or second generation cephalosporins sometimes in association with vancomycin seem appropriate in this context. It is now urgent to conduct clinical trials in order to validate theses propositions.

[A fatal case of Herpes simplex virus meningoencephalitis in an immunocompetent adult]. / Un cas mortel de méningoencéphalite à Herpes simplex virus chez un adulte immunocompétent.

Management of herpes simplex virus encephalitis (HSE) has been considerably improved by the development of rapid polymerase chain reaction (PCR) assays and by the use of intravenous acyclovir. However, an absence of early antiviral treatment has been associated to a poor outcome in patients with HSE. In the present report, we described the case of a 53 years-old adult immunompetent patient who was admitted to the emergency department of university medical center of Reims (France). At the time of hospitalisation, he was suffering from a febrile encephalitis syndrome evolving for more than 24 hours. A cerebrospinal fluid (CSF) puncture was performed demonstrating the presence of a lymphocytic meningitidis (42 leukocytes/mm3 which 90% of mononuclear cells; CSF protein = 1650 mg/L) associated with high levels of interferon alpha (75 UI/mL). Specific herpesvirus PCR and hybridisation assays (Herpes Consensus Hybridowell, Argene, France) were positive for the detection of HSV-1 genome on this CSF sample. Despite the intravenous acyclovir treatment (15 mg/kg/8 hours) delivered at the time of hospitalisation, this immunocompetent adult patient will dead 15 days later by a cardiorespiratory failure that was related to extensive HSE lesions. The time delay between the beginning of the clinical syndrome and the instauration of intravenous acyclovir treatment (more than 24 hours) was the only point susceptible to explain the presence of extensive CNS lesions in this patient. Specific Herpesvirus PCR detection assays are powerful tools that are actually used to establish a rapid etiological diagnosis of viral meningo-encephalitis. However, in patients demonstrating clinical signs of encephalitis associated with an aseptic CSF, it remains essential to urgently initiate a presumptive intravenous acyclovir treatment (10-15 mg/kg/8 hours). Actually, this medical practice is the only one susceptible to reduce the morbi-mortality rates linked to HSE.