Severe bacterial infections in children. Inquiry by the paediatric Mobile Intensive Care Unit AP/HP in the Ile-de-France area.

This study involves 106 infants (neonatal period ruled out), victims of sev ere 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 (h ome, medical room, airport) and primary-secondary interventions (hospital e mergencies) whereas 53,8% are related to secondary transports of infants wh o have been hospitalized and suffered from severe bacterial disorders compl icating their original disease. 51% are meningitidis infections, rather due to streptococcus pneumoniae and meningococcis, associated with severe infe ctious purpura. 20,75% are toxic shock syndromes in patients suffering from chronic affections (sickle cell anemia), acquired or congenital immunodefi ciencies; 19,8% of the cases are severe bacterial pneumonia (staphylococcal pleuro-pneumopathies, bordetella pertussis cough) or surinfected viral inf ections (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 a re particularly severe, because of their pronostic (10 deaths, 8 severe seq uelae among the 26 cases). These observations prompted us to recommend earl y immunization of infants at 2-3 months post natal age by the new vaccine c onjugated up to 7 valences such as "Prevenar (R)". If this vaccine have bee n available for this patient series, may be avoided 8 deaths, 7 severe sequ elae, with I septic shock syndrome due to streptococcus pneumoniae and anot her serious infection in a homozygous sickle cell disease. (C) 2001 Edition s scientifiques et medicales Elsevier SAS.