Pediatric deaths due to community-acquired bacterial infections. A french survey in Pediatric Intensive Care Units

A retrospective survey has been conducted in the Pediatric Intensive Care U nits (PICUs) affiliated to the Groupe Francophone d'Urgence et de Reanimati on Pediatrique over two years (1999 and 2000). The purpose was to determine the number of children aged from 10 days to 18 years who died from communi ty acquired bacterial infections and to compare the data to those obtained from official surveys (statistics of death from the Institut National de la Sante et de la Recherche Medicale) and from the Institut National de Veill e Sanitaire as well as from punctual studies. Thirty two (60%) PICUs have p articipated and 100 cases of children without known risk factors, dead from community acquired documented bacterial infection have been considered for analysis (36 in 1999, 54 in 2000). Infants aged between 10 days and 2 mont hs represent 1/3 of the fatalities. Neisseria meningitidis is the first pat hogen responsible for death (34% including 10 not documented cases of purpu ra fulminans). B group is predominent (14/24) compared to the C group (6 ca ses). A lethal infection due to W135 group occured in 2 infants in 2000. St reptococcus pneumoniae is the second pathogen responsible for death (28%). None of the cases were due to antibiotic resistant pneumococcus. Bordetella pertussis is surprisingly the third pathogen responsible for death (13%), all of them being younger than 2 months. Pertussis is the first cause of de ath in infants aged 10 days - 2 months. An important increase was observed between 1999 (3 cases) and 2000 (10 cases). Meningitis is the first disease responsible for death (42%): 26 are related to pneumococcus, 5 to meningoc occus and 6 to group B streptococcus. Purpura fulminans is the second cause (30%), due mainly to group B meningococus (11 cases). Group C meningococus accounts for 6 cases only. One case is related to pneumococcus. Lung infec tions are a rare cause of death (5 cases) and particulary staphylococcal pl euro pneumonia seems to be no longer a significative cause of fatality Toxi c shock syndrome is an emergent disease responsible for 5 death (2 staphylo coccal, 3 streptococcal). These data fit with those provided by the Institu t National de Veille Sanitaire with respect to meningococcal infections and the Renacoq network with respect to pertussis, as well as the data provide d by a previous GPIP survey on pneumococcal meningitis. However, the data p rovided by INSERM seem not to be relevant. In spite of the bias due to a re trospective study and the lack of exhaustivity, this survey provides data w hich could help decision making with respect to new vaccines against pneumo coccus. (C) 2001 Editions scientifiques et medicales Elsevier SAS.