F Dubos

Centre Hospitalier Régional Universitaire de Lille, Lille, Nord-Pas-de-Calais, France

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Publications (138)227.3 Total impact

  • A Martinot, F Dubos
    Archives de Pédiatrie 05/2015; 22(5 Suppl 1):174-5. DOI:10.1016/S0929-693X(15)30086-5 · 0.41 Impact Factor
  • Archives de Pédiatrie 05/2015; 22(5 Suppl 1):186-7. DOI:10.1016/S0929-693X(15)30093-2 · 0.41 Impact Factor
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    ABSTRACT: Skills in pediatric infectious disease (PID) and antibiotic management are of critical importance in hospitals. This nationwide survey aimed to assess the characteristics, training, and tasks of PID consultants in French hospitals. The management of PID and antibiotic therapy was also analyzed in hospitals lacking PID consultants. An electronic survey linked to a dedicated website was sent to French hospitals with a pediatric department in June 2012. In hospitals where PID consultants were available, they were asked to answer the questionnaire. In hospitals lacking PID consultants, pediatricians were asked to send the questionnaire to their infectious disease consultant, if available. A total of 86 individual responses were received from 76 hospitals (including 26 academic hospitals). The existence of a PID consultant was declared in 53 hospitals. Responses were received from the person claiming to be "the" or "one of the" PID consultants in 46 cases, representing 39 centers. PID consultants had a degree in PID (46%) or antibiotic therapy (37%), or a complementary qualification as a specialist in infectious diseases (13%). The PID consultants worked in departments of general pediatrics (61%) and emergency medicine (15%), or neonatology (15%). They were involved in the Nosocomial Infection Prevention Committee (43%) or the Antimicrobial Therapy Committee (63%) and had teaching activities (65%). There was a specific unit with a PID label in 10% of the 39 centers reporting at least one consultant and consultations of infectious diseases took place in 28%. PID consultants are rare. Their important role in patient care should be recognized. Efforts should focus on recruiting and training such specialists. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
    Archives de Pédiatrie 03/2015; DOI:10.1016/j.arcped.2015.02.007 · 0.41 Impact Factor
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    ABSTRACT: Myxoma resistance protein 1 (MxA) is induced during viral infections. MxA testing could be helpful to differentiate between viral and bacterial infections. A prospective multicenter cohort study was performed in pediatric emergency departments. MxA blood values were measured in children with confirmed viral or bacterial infections, uninfected controls, and infections of unknown origin. First patients were used to determine MxA threshold for viral infection. The diagnostic performance of MxA was determined by using receiver operating characteristic (ROC) analysis. Sensitivities (Se), specificities (Sp), and positive and negative likelihood ratios (LR+, LR-) were calculated. The study included 553 children; 44 uninfected controls and 77 confirmed viral infections (mainly respiratory syncytial virus and rotavirus) were used to determine an MxA threshold at 200 ng/mL. In the 193 other patients with confirmed infections and uninfected controls (validation group), MxA was significantly higher in patients with viral than in those with bacterial infections and uninfected controls (P < .0001). The area under the ROC curve (AUC) were 0.98, with 96.4% Se and 85.4% Sp, for differentiating uninfected from virus-infected patients and 0.89, with 96.4% Se and 66.7% Sp, for differentiating bacterial and viral infections. MxA levels were significantly higher in patients with clinically diagnosed viral versus clinically diagnosed bacterial infections (P < .001). Some patients with Streptococcus pneumonia infections had high MxA levels. Additional studies are required to elucidate whether this was due to undiagnosed viral coinfections. MxA is viral infection marker in children, at least with RSV and rotavirus. MxA could improve the management of children with signs of infection. Copyright © 2015 by the American Academy of Pediatrics.
    PEDIATRICS 03/2015; 135(4). DOI:10.1542/peds.2014-1946 · 5.30 Impact Factor
  • Archives de Pédiatrie 01/2015; DOI:10.1016/j.arcped.2014.10.005 · 0.41 Impact Factor
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    ABSTRACT: To determine the rate of therapeutic management satisfying the institutional protocol for children with urinary tract infection (UTI) in the context of the emergence of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. A retrospective, single-center, observational study was carried out for 1 year (2010-2011). Data from all children admitted to the emergency department with a diagnosis of UTI were analysed. Adherence to the protocol was evaluated for the initial management and at re-evaluation with the definitive result of the urine culture. Risk factors for nonadherence were analysed. Among the children, 393 were included. An ESBL Enterobacteriaceae-related UTI was identified in 2.2% of urine analyses. The initial therapeutic management satisfied the protocol for 95% of children and at re-evaluation for 80%. Nonadherence was related to poorly adapted treatment (59%) and an erroneous indication of dual antibiotic therapy (20%). Variables associated with the inadequacy of the initial management were age less than 3 months (adjusted OR [aOR]: 9.3; 95%CI: 3.5-24.8) and at re-evaluation age under 3 months (aOR: 12.8; 95%CI: 5.5-29.9) and an unconfirmed infection in the final urine culture (aOR: 30.8; 14.7-64.3). Adherence to the protocol was good but could be increased by a better re-evaluation procedure with the result of the urine culture. ESBL Enterobacteriaceae-related UTIs were still rare enough to influence the efficacy of management. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
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    ABSTRACT: Background. Clinical decision rules (CDRs) have sought to identify the few children with chemotherapy-induced febrile neutropenia (FN) really at risk of severe infection to reduce the invasive procedures and costs for those at low risk. Several reports have shown that most rules do not perform well enough to be clinically useful. Our objective was to analyze the derivation methods and validation procedures of these CDRs. Procedure. A systematic review using Medline, Ovid, Refdoc, and the Cochrane Library through December 2012 searched for all CDRs predicting the risk of severe infection and/or complications in children with chemotherapy-induced FN. Their methodological quality was analyzed by 17 criteria for deriving and validating a CDR identified in the literature. The criteria published by the Evidence Based Medicine Working Group were applied to the published validations of each CDR to assess their level of evidence. Results. The systematic research identified 612 articles and retained 12 that derived CDRs. Overall, the CDRs met a median of 65% of the methodological criteria. The criteria met least often were that the rule made clinical sense, or described the course of action, or that the variables and the CDR were reproducible. Only one CDR, developed in South America, met all methodological criteria and provided the highest level of evidence; unfortunately it was not reproducible in Europe. Conclusion. Only one CDR developed for children with FN met all methodological standards and reached the highest level of evidence. (C) 2014 Wiley Periodicals, Inc.
    Pediatric Blood & Cancer 10/2014; 61(10). DOI:10.1002/pbc.25106 · 2.56 Impact Factor
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    ABSTRACT: The incidence of childhood bone and joint infections (BJIs) is not well known, but is useful for identifying epidemiological differences and improving practice.
    Archives of Disease in Childhood 09/2014; 100(2). DOI:10.1136/archdischild-2013-305860 · 2.91 Impact Factor
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    ABSTRACT: Objective To determine how national recommendations for the treatment of acute community-acquired pneumonia (CAP) are applied in children. Methods A phone survey was conducted in northern France. A standardized questionnaire was submitted to randomized general practitioners (GPs), private pediatricians, and pediatric fellows to analyze their practices for CAP in children. Diagnostic and treatment data were collected for the last child they had treated for CAP and for a factitious clinical case of CAP. Treatments, particularly prescribing antibiotics, were compared to the guidelines published in 2005 for lower respiratory tract infections, in order to determine the percentage of “good prescribers”. Results A total of 101 physicians were involved: 77 senior physicians (62 GPs and 15 private pediatricians) and 24 pediatric fellows. For the last child treated for a CAP (mean age: 4.5 years ± 3.4), amoxicillin was prescribed in 29% of cases and associated (most of the time by GPs) with clavulanic acid in 54%. For the factitious clinical case (age: 3 years), amoxicillin alone was prescribed in 50% of cases and associated with clavulanic acid in 45%. Also considering recommended doses and length of treatment, the percentage of “good prescribers” for senior physicians for each situation was 15% and 16%, respectively, and for pediatric residents was 52% and 50%. Conclusion Guidelines for CAP in children were insufficiently followed.
    Archives de Pédiatrie 08/2014; 21(8):827–833. DOI:10.1016/j.arcped.2014.05.011 · 0.41 Impact Factor
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    ABSTRACT: Background and purpose Plain radiographs may fail to reveal an ankle fracture in children because of developmental and anatomical characteristics. In this systematic review and meta- analysis, we estimated the prevalence of occult fractures in children with acute ankle injuries and clinical suspicion of fracture, and assessed the diagnostic accuracy of ultrasound (US) in the detection of occult fractures. Methods We searched the literature and included studies reporting the prevalence of occult fractures in children with acute ankle injuries and clinical suspicion of fracture. Proportion meta-analysis was performed to calculate the pooled prevalence of occult fractures. For each individual study exploring the US diagnostic accuracy, we calculated US operating characteristics. Results 9 studies (involving 187 patients) using magnetic resonance imaging (MRI) (n = 5) or late radiographs (n = 4) as reference standard were included, 2 of which also assessed the diagnostic accuracy of US. Out of the 187 children, 41 were found to have an occult fracture. The pooled prevalence of occult fractures was 24% (95% CI: 18–31). The operating characteristics for detection of occult ankle fractures by US ranged in positive likelihood ratio (LR) from 9 to 20, and in negative LR from 0.04 to 0.08. Interpretation A substantial proportion of fractures may be overlooked on plain radiographs in children with acute ankle injuries and clinical suspicion of fracture. US appears to be a promising method for detection of ankle fractures in such children when plain radiographs are negative.
    Acta Orthopaedica 05/2014; 85(5):1-7. DOI:10.3109/17453674.2014.925353 · 2.45 Impact Factor
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    ABSTRACT: Aim: This study sought to evaluate the initial management of children with parapneumonic effusion admitted to all French university hospitals. Methods: A nationwide survey of all 35 university hospitals took place in 2011 to assess practices for children with parapneumonic effusion, using a hypothetical clinical vignette and a standardised questionnaire. Two to four paediatricians per hospital were interviewed and asked about their initial management, probabilistic antibiotic therapy and its adaptation to microbiological results and subsequent course. Answers from paediatricians working in emergency departments, intensive care units and conventional paediatric units were compared. Results: Of the 100 paediatricians contacted, 95 responded. Of these, 98% would order an initial blood test, 70% would order diagnostic thoracentesis, and all would start immediate antibiotic therapy: 31% with a single drug, 67% with two drugs and 2% with three drugs. The most frequent initial choices were third-generation cephalosporin alone (17%) or combined with rifampicin (34%) or vancomycin (24%). Adaptation varied according to drug used, dose and duration, especially when the microorganism was not Streptococcus pneumoniae. Practices did not differ significantly among the different groups of paediatricians. Conclusion: Standardised management of parapneumonic effusion, including routine thoracentesis and more consistent prescription of antibiotics, is needed.
    Acta paediatrica (Oslo, Norway: 1992). Supplement 05/2014; 103(9). DOI:10.1111/apa.12702
  • Archives de Pédiatrie 05/2014; 21(5):677. DOI:10.1016/S0929-693X(14)71937-2 · 0.41 Impact Factor
  • Archives de Pédiatrie 05/2014; 21(5):966. DOI:10.1016/S0929-693X(14)72226-2 · 0.41 Impact Factor
  • Archives de Pédiatrie 05/2014; 21(5):967. DOI:10.1016/S0929-693X(14)72227-4 · 0.41 Impact Factor
  • Archives de Pédiatrie 05/2014; 21(5):362. DOI:10.1016/S0929-693X(14)71622-7 · 0.41 Impact Factor
  • Archives de Pédiatrie 05/2014; 21(5):969. DOI:10.1016/S0929-693X(14)72229-8 · 0.41 Impact Factor
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    ABSTRACT: Background. About 10% of pediatric patients with invasive pneumococcal disease (IPD) die from the disease. Some primary immunodeficiencies (PIDs) are known to confer predisposition to IPD. However, a systematic search for these PIDs has never been carried out in children presenting with IPD. Methods. We prospectively collected pediatric cases of IPD requiring hospitalization, between 2005 and 2011, in 28 pediatric wards throughout France. IPD was defined as a positive pneumococcal culture, PCR result and/or soluble antigen detection at a normally sterile site. The immunological assessment included abdominal ultrasound, whole-blood counts and smears, determinations of plasma Ig and complement levels, and the evaluation of pro-inflammatory cytokines. Results. We included a total of 163 children with IPD (M/F sex ratio: 1.3, median age: 13 months). Seventeen children had recurrent IPD. Meningitis was the most frequent type of infection (87%), others were pleuropneumonitis, isolated bloodstream infection, osteomyelitis, endocarditis and mastoiditis. One patient with recurrent meningitis had a congenital cerebrospinal fluid fistula. The results of immunological explorations were abnormal in 26 children (16%) and a PID was identified in 17 patients (10%), including one case of MyD88 deficiency, three of complement fraction C2 or C3 deficiencies, one of isolated congenital asplenia and two of Bruton's agammaglobulinemia. The proportion of PIDs was much higher in children older than two years than in younger children (26% vs 2%, p<0.001). Conclusions. Children with IPD should undergo immunological investigations, particularly those older than two years, as PIDs may be discovered in up to 26% of cases.
    Clinical Infectious Diseases 04/2014; 59(2). DOI:10.1093/cid/ciu274 · 9.42 Impact Factor
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    ABSTRACT: Background. Pneumococcal serotypes 1, 3, 5, 7F, and 19A were the most implicated in community-acquired pneumonia (CAP) after implementation of 7-valent pneumococcal conjugate vaccine (PCV7). In France, the switch from PCV7 to 13-valent pneumococcal conjugate vaccine (PCV13) occurred in June 2010. An active surveillance network was set up to analyze the impact of PCV13 on CAP. Methods. An observational prospective study performed in 8 pediatric emergency departments from June 2009 to May 2012 included all children between 1 month and 15 years of age with chest radiography-confirmed pneumonia. Three 1-year periods were defined: pre-PCV13, transitional, and post-PCV13. Results. During the 3-year study period, among the 953 274 pediatric emergency visits, 5645 children with CAP were included. CAP with pleural effusion and documented pneumococcal CAP were diagnosed in 365 and 136 patients, respectively. Despite an increase (4.5%) in number of pediatric emergency visits, cases of CAP decreased by 16% (2060 to 1725) between pre- and post-PCV13 periods. The decrease reached 32% in infants in the same periods (757 to 516; P < .001). Between pre- and post-PCV13 periods, the proportion of CAP patients with a C-reactive protein level >120 mg/dL decreased from 41.3% to 29.7% (P < .001), the number of pleural effusion cases decreased by 53% (167 to 79; P < .001) and the number of pneumococcal CAP cases decreased by 63% (64 to 24; P = .002). The number of additional PCV13 serotypes identified decreased by 74% (27 to 7). Conclusions. Our data suggest a strong impact of PCV13 on CAP, pleural effusion, and documented pneumococcal pneumonia, particularly cases due to PCV13 serotypes.
    Clinical Infectious Diseases 02/2014; 58(7). DOI:10.1093/cid/ciu006 · 9.42 Impact Factor
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    ABSTRACT: Chemotherapy-induced febrile neutropenia is a frequent event in children with cancer, with a high morbidity. Antibiotic prophylaxis has been proposed for many years to prevent infectious diseases in patients with neutropenia. Fluoroquinolone prophylaxis induced a significant reduction of mortality and infectious morbidities in these situations. Less data are available in children with neutropenia. The emergence of antimicrobial resistance involving not only quinolones, but also cephalosporins, aminoglycosides and penems, is the main long term risk. This article summarise the usefulness of the prophylactic antibiotic treatment and its perspective in children with cancer.
    Archives de Pédiatrie 11/2013; 20 Suppl 3:S90-3. DOI:10.1016/S0929-693X(13)71415-5 · 0.41 Impact Factor
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    ABSTRACT: Rapid group A Streptococcus (GAS) antigen detection tests (RDT) have high diagnostic performance for the management of acute pharyngitis and are recommended before any antibiotic (ATB) prescription in France to reduce ATB use. The rate of general practitioners (GPs) using GAS RDT is low and decreasing. Our aims were to describe the reasons for pediatricians and GPs not using RDT or for prescribing ATB despite of a negative RDT. In 2011, a survey was conducted in a random sample of 368 GPs plus all ambulatory pediatricians (n=82) in the Nord-Pas-de-Calais region of France. Response rates were 74% (n=61) for pediatricians and 18% (n=68) for GPs. RDTs for pharyngitis were used by 75% [95% CI: 63-85] of pediatricians and 53% [95% CI: 41-64] of GPs (P<0.001). RDTs were systematically used in children 3years of age and older by only 59% of all physicians using RDTs. An ATB was systematically prescribed in case of positive RDT by 96% of physicians and eventually prescribed in case of negative RDT by 74%. The main reasons for ATB prescription in case of negative RDT were association with otitis media (51%), second visit for the same pharyngitis (45%), and high clinical suspicion of GAS pharyngitis (36%). Forty percent of non-RDT users had used them in the past. The 3 main reasons for not using RDT were the lack of time (57%), high confidence in clinical data to discriminate GAS pharyngitis (48%), and low confidence in RDT (27%). This survey highlights the lack of knowledge about low and high discriminant values of clinical data and RDT, respectively, especially the excellent negative predictive value of RDTs, and an erroneous assessment of the low risk of missing GAS pharyngitis compared to the consequences of inappropriate ATB use.
    Archives de Pédiatrie 08/2013; 20(10). DOI:10.1016/j.arcped.2013.07.002 · 0.41 Impact Factor

Publication Stats

608 Citations
227.30 Total Impact Points

Institutions

  • 2008–2015
    • Centre Hospitalier Régional Universitaire de Lille
      Lille, Nord-Pas-de-Calais, France
    • Hôpital Jean-Verdier – Hôpitaux Universitaires Paris-Seine-Saint-Denis
      Bondy, Île-de-France, France
  • 2007–2014
    • University of Lille Nord de France
      Lille, Nord-Pas-de-Calais, France
    • University of Udine
      Udine, Friuli Venezia Giulia, Italy
  • 2006–2010
    • Université René Descartes - Paris 5
      • Faculty of medicine
      Lutetia Parisorum, Île-de-France, France
  • 2006–2009
    • Université du Droit et de la Santé Lille 2
      Lille, Nord-Pas-de-Calais, France
  • 2005
    • Hôpital Saint-Vincent-de-Paul – Hôpitaux universitaires Paris Centre
      Lutetia Parisorum, Île-de-France, France
  • 2004
    • Centre Hospitalier de CAYENNE Andrée ROSEMON
      Cayenne, Guyane, French Guiana