F Dubos

University of Lille Nord de France, Lille, Nord-Pas-de-Calais, France

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Publications (126)189.43 Total impact

  • Archives de Pédiatrie. 01/2015;
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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.
    Archives de pediatrie : organe officiel de la Societe francaise de pediatrie. 11/2014;
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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;
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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.
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    ABSTRACT: To determine how national recommendations for the treatment of acute community-acquired pneumonia (CAP) are applied in children.
    Archives de pediatrie : organe officiel de la Societe francaise de pediatrie. 07/2014;
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    ABSTRACT: 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.
    Pediatric Blood & Cancer 06/2014; · 2.35 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;
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    ABSTRACT: This study sought to evaluate the initial management of children with parapneumonic effusion admitted to all French university hospitals.
    Acta paediatrica (Oslo, Norway: 1992). Supplement 05/2014;
  • Archives de Pédiatrie 05/2014; 21(5):677. · 0.36 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; · 9.37 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; · 9.37 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. · 0.36 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; · 0.36 Impact Factor
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    ABSTRACT: Non-invasive diagnostic tools for invasive fungal infection are used widely in clinical microbiology. To our knowledge, fungal beta-glucans detection, directly in human tissues has never been considered so far. We showed here that this approach could be useful to manage culture-negative biopsies, when an invasive fungal infection is suspected.
    The Journal of infection 08/2013; · 4.13 Impact Factor
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    ABSTRACT: From 2001 to 2008, 119 pediatric cases of meningococcal disease caused by serogroup W were reported in France. They cases represented 4% of all meningococcal disease cases in children and were mostly in infants (54%). Meningitis occurred in 78 (66%) patients but differed by isolate. Isolates of the clonal complex sequence type-22 were associated with nonmeningeal presentation. Further investigations of clinical tropism of meningococcal W isolates are warranted.
    The Pediatric Infectious Disease Journal 07/2013; 32(7):798-800. · 3.57 Impact Factor
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    ABSTRACT: A medication-related cause must be sought when unusual symptoms occur. Topical treatments, including eye drops, whose side effects are more common in exposed children, need to be verified. We report here the cases of two children who developed systemic symptoms after the administration of atropine-based mydriatic eye drops. A 6-month-old boy was admitted to the emergency department with acute urine retention lasting 36 h. Investigations identified only eye drop treatment 3 h before the onset of symptoms, with 2 drops of homatropine 1 %, as a cause. No other urinary retention was observed during the 1-year follow-up. A 2-year-old boy was admitted to the emergency department for drowsiness, thirst, and dry mouth 30 min after the administration of three eye drops of atropine 1 % instead of atropine 0.3 % (error made by the pharmacy). Symptoms disappeared after 6 h. Both observations highlight the possible side effects related to mydriatic eye drops. Indeed, because of small penetration of such medications in the eye, a high concentration of the active part of the medication is contained in each drop. In young children, at least 20 to 40 % of the volume of a drop drains into the nasolacrimal duct and thereby into the systemic circulation, without passage through the liver. A close national pharmacologic vigilance follow-up has been set up for atropine-based mydriatic eye drops in young children, who are the most exposed to systemic and potentially severe complications of these medications. We emphasize the appropriate procedure for the use of eye drops in young children to limit systemic passage, with only a 0.3 % maximum atropine concentration in infants, compression of the internal angle of the eye for at least 1 min, and at least a 15-mins interval between two eye drop administrations.
    Archives de Pédiatrie 04/2013; 20(4):391–394. · 0.36 Impact Factor
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    ABSTRACT: A medication-related cause must be sought when unusual symptoms occur. Topical treatments, including eye drops, whose side effects are more common in exposed children, need to be verified. We report here the cases of two children who developed systemic symptoms after the administration of atropine-based mydriatic eye drops. A 6-month-old boy was admitted to the emergency department with acute urine retention lasting 36h. Investigations identified only eye drop treatment 3h before the onset of symptoms, with 2 drops of homatropine 1 %, as a cause. No other urinary retention was observed during the 1-year follow-up. A 2-year-old boy was admitted to the emergency department for drowsiness, thirst, and dry mouth 30min after the administration of three eye drops of atropine 1 % instead of atropine 0.3 % (error made by the pharmacy). Symptoms disappeared after 6h. Both observations highlight the possible side effects related to mydriatic eye drops. Indeed, because of small penetration of such medications in the eye, a high concentration of the active part of the medication is contained in each drop. In young children, at least 20 to 40 % of the volume of a drop drains into the nasolacrimal duct and thereby into the systemic circulation, without passage through the liver. A close national pharmacologic vigilance follow-up has been set up for atropine-based mydriatic eye drops in young children, who are the most exposed to systemic and potentially severe complications of these medications. We emphasize the appropriate procedure for the use of eye drops in young children to limit systemic passage, with only a 0.3 % maximum atropine concentration in infants, compression of the internal angle of the eye for at least 1min, and at least a 15-mins interval between two eye drop administrations.
    Archives de Pédiatrie 02/2013; · 0.36 Impact Factor
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    ABSTRACT: To identify the best clinical decision rules (CDRs) for diagnosing group A streptococcal (GAS) pharyngitis in children. A combination of symptoms could help clinicians exclude GAS infection in children with pharyngitis. Systematic review and meta-analysis of original articles involving CDRs in children. The Pubmed, OVID, Institute for Scientific and Technical Information and Cochrane databases from 1975 to 2010 were screened for articles that derived or validated a CDR on a paediatric population: 171 references were identified. Any reference including primary care for children with pharyngitis. The methodological quality of the articles selected was analysed according to published quality standards. A meta-analysis was performed to assess the statistical performance of the CDRs and their variables for the diagnosis of GAS pharyngitis. The main criterion was a false-negative rate in the whole population not any worse than that of a rapid diagnostic test strategy for all patients (high sensitivity and low negative likelihood ratio). 4 derived and 12 validated CDRs for this diagnosis in children. These articles involved 10 523 children (mean age, 7 years; mean prevalence of GAS pharyngitis, 34%). No single variable was sufficient for diagnosis. Among the CDRs, that of Joachim et al had a negative likelihood ratio of 0.3 (95% CI 0.2 to 0.5), resulting in a post-test probability of 13%, which leads to 3.6% false-negative rate among low-risk patients and 10.8% overall, equivalent to rapid diagnostic tests in some studies. The rule of Joachim et al could be useful for clinicians who do not use rapid diagnostic tests and should allow avoiding antibiotic treatment for the 35% of children identified by the rule as not having GAS pharyngitis. Owing to its poor specificity, such CDR should be used to focus rapid diagnostic tests to children with high risk of GAS pharyngitis to reduce the antibiotic consumption.
    BMJ Open 01/2013; 3(3). · 2.06 Impact Factor
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    ABSTRACT: Of major concern in any febrile child presenting with a seizure is the possibility of bacterial meningitis (BM). We did a systematic review to estimate the risk of BM among various subgroups of young children with a first seizure in the context of fever, and to assess the utility of routine lumbar puncture (LP) in children with an apparent first FS. MEDLINE, INIST, and the COCHRANE Library databases were searched from inception to December 2011 for published studies, supplemented by manual searches of bibliographies of potentially relevant articles and review articles. Studies reporting the prevalence of BM in young children presenting to emergency care with a first: i) "seizure and fever", ii) apparent simple FS, and iii) apparent complex FS were included. Fourteen studies met the inclusion criteria. In children with a first "seizure and fever", the pooled prevalence of BM was 2.6% (95% CI 0.9-5.1); the diagnosis of BM might be suspected from clinical examination in 95% of children >6 months. In children with an apparent simple FS, the average prevalence of BM was 0.2% (range 0 to 1%). The pooled prevalence of BM among children with an apparent complex FS was 0.6% (95% CI 0.2-1.4). The utility of routine LP for diagnosis of CNS infections requiring immediate treatment in children with an apparent first FS was low: the number of patients needed to test to identify one case of such infections was 1109 in children with an apparent first simple FS, and 180 in those with an apparent first complex FS. The values provided from this study provide a basis for an evidence-based approach to the management of different subgroups of children presenting to emergency care with a first seizure in the context of fever.
    PLoS ONE 01/2013; 8(1):e55270. · 3.53 Impact Factor
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    ABSTRACT: Dehydration secondary to gastroenteritis is one of the most common reasons for office visits and hospital admissions. The indicator most commonly used to estimate dehydration status is acute weight loss. Post-illness weight gain is considered as the gold-standard to determine the true level of dehydration and is widely used to estimate weight loss in research. To determine the value of post-illness weight gain as a gold standard for acute dehydration, we conducted a prospective cohort study in which 293 children, aged 1 month to 2 years, with acute diarrhea were followed for 7 days during a 3-year period. The main outcome measures were an accurate pre-illness weight (if available within 8 days before the diarrhea), post-illness weight, and theoretical weight (predicted from the child's individual growth chart). Post-illness weight was measured for 231 (79%) and both theoretical and post-illness weights were obtained for 111 (39%). Only 62 (21%) had an accurate pre-illness weight. The correlation between post-illness and theoretical weight was excellent (0.978), but bootstrapped linear regression analysis showed that post-illness weight underestimated theoretical weight by 0.48 kg (95% CI: 0.06-0.79, p<0.02). The mean difference in the fluid deficit calculated was 4.0% of body weight (95% CI: 3.2-4.7, p<0.0001). Theoretical weight overestimated accurate pre-illness weight by 0.21 kg (95% CI: 0.08-0.34, p = 0.002). Post-illness weight underestimated pre-illness weight by 0.19 kg (95% CI: 0.03-0.36, p = 0.02). The prevalence of 5% dehydration according to post-illness weight (21%) was significantly lower than the prevalence estimated by either theoretical weight (60%) or clinical assessment (66%, p<0.0001).These data suggest that post-illness weight is of little value as a gold standard to determine the true level of dehydration. The performance of dehydration signs or scales determined by using post-illness weight as a gold standard has to be reconsidered.
    PLoS ONE 01/2013; 8(1):e55063. · 3.53 Impact Factor

Publication Stats

382 Citations
189.43 Total Impact Points

Institutions

  • 2007–2014
    • University of Lille Nord de France
      Lille, Nord-Pas-de-Calais, France
  • 2011
    • University of Oxford
      • Centre for Statistics in Medicine
      Oxford, ENG, United Kingdom
  • 2006–2010
    • Université René Descartes - Paris 5
      • Faculty of medicine
      Lutetia Parisorum, Île-de-France, France
  • 2004–2010
    • Centre Hospitalier Régional Universitaire de Lille
      • Division of Neurology
      Lille, Nord-Pas-de-Calais, France
  • 2009
    • Université du Droit et de la Santé Lille 2
      Lille, Nord-Pas-de-Calais, France
  • 2005–2008
    • Hôpital Saint-Vincent-de-Paul – Hôpitaux universitaires Paris Centre
      Lutetia Parisorum, Île-de-France, France