R Cohen

Centre Hospitalier Intercommunal Creteil, Créteil, Île-de-France, France

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Publications (261)162.77 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Staphylococcus aureus and Streptococcus pyogenes are the two main bacteria involved in skin infections in children. Mild infections like limited impetigo and furonculosis should preferentially be treated by topical antibiotics (mupirocine or fucidic acid). Empiric antimicrobial therapy of dermohypodermitis consists in amoxicillin-clavulanate through oral route (80mg/kg/d) or parenteral route (150mg/kg amoxicillin per d. in 3-4 doses) for complicated features: risk factors of extension of the infection, sepsis or fast evolution. Clindamycin (40mg/kg/d per d. in 3 doses) should be added to the beta-lactam treatment in case of toxinic shock, surgical necrotizing soft tissues or fasciitis infections.
    Archives de pediatrie : organe officiel de la Societe francaise de pediatrie. 06/2014;
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    ABSTRACT: For the past 20years, three vaccines against the three main bacterial species implicated in meningitis in children have been included in the French vaccine calendar: Haemophilus influenzae b in 1993, 7-valent pneumococcal conjugate vaccine (PCV7) in 2003 (replaced by 13-valent in 2010) and Neisseria meningitidis C in 2009. The French active surveillance network from the GPIP/ACTIV monitors the change in the epidemiological, clinical, and biological features of bacterial meningitis due to vaccine use.
    Archives de pediatrie : organe officiel de la Societe francaise de pediatrie. 06/2014;
  • Archives de pediatrie : organe officiel de la Societe francaise de pediatrie. 06/2014;
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    ABSTRACT: Recommendations for the use of diagnostic testing in low respiratory infection in children older than 3months were produced by the Groupe de Recherche sur les Avancées en Pneumo-Pédiatrie (GRAPP) under the auspices of the French Paediatric Pulmonology and Allergology Society (SP(2)A). The Haute Autorité de santé (HAS) methodology, based on formalized consensus, was used. A first panel of experts analyzed the English and French literature to provide a second panel of experts with recommendations to validate. Only the recommendations are presented here, but the full text is available on the SP(2)A website.
    Archives de Pédiatrie 03/2014; · 0.36 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: We used data from the Groupe de pathologie infectieuse pédiatrique and Association clinique et thérapeutique infantile du Val-de-Marne (GPIP/ACTIV) National Survey of Bacterial Meningitis in children and the National Reference Center for Meningococci (CNRM) microbiological data to assess the potential impact of corticosteroids on the immediate management of invasive meningococcal disease (IMD) associated with different genotypes, including highly pro-inflammatory strains of the ST-11 clonal complex (genotype ST-11). From 2001 to 2009, 259 pediatric wards and 168 microbiology laboratories distributed throughout France prospectively included all under-18-year-old patients with IMD (meningitis or purpura fulminans). The strains were sent to the CNRM for genotyping. We linked the ACTIV clinical data of IMD cases, where information on corticosteroid therapy was available, to strains isolated by the CRNM. A total of 1981 IMD cases were identified during the 8-year study, 805 cases (712 [88.5%] bacterial meningitis and 93 [11.5%] purpura fulminans) had steroid treatment data (33.8% received corticosteroids). The genotype of the strains was available for 410 patients (24.4% related to genotype ST-11; 100 patients). For all cases and regardless of the corticosteroids, mortality was significantly associated with the genotype ST-11 (OR=2.39, 95% CI [1.29; 4.42], P=0.004). For all cases and regardless of the genotypes of the isolates, mortality was also significantly higher for children with than without corticosteroid therapy (12.7% versus 4.5%, P<0.001). However, this treatment had been prescribed more frequently in severe cases, including shock, PF, coma and/or mechanical ventilation. For children who did not receive corticosteroids, the mortality rate was significantly higher with genotype ST-11 compared to other genotypes (OR=4.68 [1.91, 11.46], P=0.001). This difference disappeared in children who received corticosteroids. This study indicates that in the absence of corticosteroids, higher mortality in invasive meningococcal disease is associated with the ST-11 clonal complex strains. This suggests a possible positive effect of corticosteroid therapy depending on the genotype of the strain involved.
    Archives de Pédiatrie 01/2014; · 0.36 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Recommendations for the use of diagnostic testing in low respiratory infection in children older than 3 months were produced by the Groupe de Recherche sur les Avancées en Pneumo-Pédiatrie (GRAPP) under the auspices of the French Paediatric Pulmonology and Allergology Society (SP2A). The Haute Autorité de santé (HAS) methodology, based on formalized consensus, was used. A first panel of experts analyzed the English and French literature to provide a second panel of experts with recommendations to validate. Only the recommendations are presented here, but the full text is available on the SP2A website.
    Archives de Pédiatrie. 01/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Staphylococcus aureus and Streptococcus pyogenes are the two main bacteria involved in skin infections in children. Mild infections like limited impetigo and furonculosis should preferentially be treated by topical antibiotics (mupirocine or fucidic acid). Empiric antimicrobial therapy of dermohypodermitis consists in amoxicillin-clavulanate through oral route (80 mg/kg/d) or parenteral route (150 mg/kg amoxicillin per d. in 3–4 doses) for complicated features: risk factors of extension of the infection, sepsis or fast evolution. Clindamycin (40 mg/kg/d per d. in 3 doses) should be added to the beta-lactam treatment in case of toxinic shock, surgical necrotizing soft tissues or fasciitis infections.
    Archives de Pédiatrie. 01/2014;
  • Archives de Pédiatrie. 01/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background For the past 20 years, three vaccines against the three main bacterial species implicated in meningitis in children have been included in the French vaccine calendar: Haemophilus influenzae b in 1993, 7-valent pneumococcal conjugate vaccine (PCV7) in 2003 (replaced by 13-valent in 2010) and Neisseria meningitidis C in 2009. The French active surveillance network from the GPIP/ACTIV monitors the change in the epidemiological, clinical, and biological features of bacterial meningitis due to vaccine use. Methods Over a 12-year period, 233 pediatric wards working with 168 microbiology departments throughout France were asked to report all cases of bacterial meningitis. Results From January 2001 to December 2012, 4808 bacterial meningitis cases were reported. Between 2001 and 2012, the number of pneumococcal meningitis (PM) cases decreased by 23.4%, and by 32.2% for children less than 2 years old. During this period, the proportion of cases attributable to PCV7 and six additional PCV13 types decreased from 63.3% to 8.1% and 83.7% to 32.4%, respectively. In 2012, the main vaccine types (accounting for 25.8% of cases) were 7F (12.2%), 19A (6.8%), and 19F (6.8%), and the most frequent non-vaccine types were 12F (14.9%), 24F (14.9%), 15B/C (6.8%), 22F (6.8%), and 10A (5.4%). In 2012, the rate of strains with decreased susceptibility to cefotaxime/ceftriaxone (MIC > 0.5 μg/mL) represented less than 3% of cases, with no identified resistant strain since 2010 (MIC > 2 μg/mL). Between 2001 (n = 67) and 2012 (n = 9), the number of NmC meningitis cases decreased by 87%. Conclusion With more than 4800 bacterial meningitis cases reported in 12 years, this nationwide survey provides essential information on the microbiological and clinical characteristics of bacterial meningitis (epidemiology or resistance data). These results could lead to changing antibiotic treatment of pneumococcal meningitis before the results of antibiotic susceptibility tests.
    Archives de Pédiatrie. 01/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives We used data from the Groupe de pathologie infectieuse pédiatrique and Association clinique et thérapeutique infantile du Val-de-Marne (GPIP/ACTIV) National Survey of Bacterial Meningitis in children and the National Reference Center for Meningococci (CNRM) microbiological data to assess the potential impact of corticosteroids on the immediate management of invasive meningococcal disease (IMD) associated with different genotypes, including highly pro-inflammatory strains of the ST-11 clonal complex (genotype ST-11). Methods From 2001 to 2009, 259 pediatric wards and 168 microbiology laboratories distributed throughout France prospectively included all under-18-year-old patients with IMD (meningitis or purpura fulminans). The strains were sent to the CNRM for genotyping. We linked the ACTIV clinical data of IMD cases, where information on corticosteroid therapy was available, to strains isolated by the CRNM. Results A total of 1981 IMD cases were identified during the 8-year study, 805 cases (712 [88.5%] bacterial meningitis and 93 [11.5%] purpura fulminans) had steroid treatment data (33.8% received corticosteroids). The genotype of the strains was available for 410 patients (24.4% related to genotype ST-11; 100 patients). For all cases and regardless of the corticosteroids, mortality was significantly associated with the genotype ST-11 (OR = 2.39, 95% CI [1.29; 4.42], P = 0.004). For all cases and regardless of the genotypes of the isolates, mortality was also significantly higher for children with than without corticosteroid therapy (12.7% versus 4.5%, P < 0.001). However, this treatment had been prescribed more frequently in severe cases, including shock, PF, coma and/or mechanical ventilation. For children who did not receive corticosteroids, the mortality rate was significantly higher with genotype ST-11 compared to other genotypes (OR = 4.68 [1.91, 11.46], P = 0.001). This difference disappeared in children who received corticosteroids. Conclusion This study indicates that in the absence of corticosteroids, higher mortality in invasive meningococcal disease is associated with the ST-11 clonal complex strains. This suggests a possible positive effect of corticosteroid therapy depending on the genotype of the strain involved.
    Archives de Pédiatrie. 01/2014;
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    ABSTRACT: Objectif En 2011, de nouvelles recommandations sur les prescriptions d’antibiotiques en cas d’otites moyennes aiguës (OMA) ont été publiées visant à réduire les prescriptions de céphalosporine de 3e génération qui favorisent le portage d’Escherichia coli producteur de ß-lactamase à spectre étendu. L’objectif de l’étude était d’évaluer l’impact des recommandations 2011 sur le type d’antibiotiques prescrits en cas d’OMA. Méthodes Entre le 1er novembre 2009 et le 31 octobre 2012, 14 661 enfants âgés de 6 à 24 mois avec un diagnostic d’OMA ont été inclus dans deux études : l’une réalisée grâce au concours de 62 pédiatres libéraux et l’autre dans 7 services d’urgences pédiatriques. Trois périodes de 1 an chacune ont été définies. Résultats Des antibiotiques ont été prescrits dans 12 471 (85,1 %) des cas. La part de l’amoxicilline a été multipliée par 25 entre la première année (2,6 %) et la dernière année (66,1 %). À l’inverse, les prescriptions de cefpodoxime proxétil et d’amoxicilline-acide clavulanique ont diminué passant respectivement de 33,6 % et 62,0 % la première année à 5,2 % et 27,7 % la dernière année. Cette évolution a été constatée tant chez les pédiatres libéraux que dans les services d’urgences pédiatriques. Conclusion Conformément aux recommandations françaises de 2011, l’amoxicilline est devenue en 2012 le premier antibiotique prescrit en cas d’OMA tandis que la part des antibiotiques à large spectre s’est réduite. Notre étude souligne l’importance de la publication de recommandations pour lutter contre la prescription d’antibiotiques à large spectre, facteur crucial dans la lutte contre la résistance bactérienne aux antibiotiques.
    Médecine et Maladies Infectieuses 01/2014; · 0.75 Impact Factor
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    ABSTRACT: Vaccination against human papillomavirus infections (HPV), introduced in the French vaccinal schedule in 2007, was recommended until the end of 2012 for 14-year-old girls, with a catch-up policy until 23years of age. We followed the evolution of this vaccine coverage rate (VC) during these 5years in the Vaccinoscopie(®) survey. We present the analysis of data collected in 2012 from a sample of 1136 mothers of girls 14 to 16years of age. They answered a self-administered questionnaire on Internet and reported all vaccinations mentioned in their daughter's health record. In 2012, respectively 12.9%, 33.6%, and 48.1% of girls 14, 15 and 16years of age had begun HPV vaccination (≥1 dose received) and respectively 4.3%, 23.6%, and 40.5% of them had received a complete vaccination schedule (3 doses), i.e. 31.7% of 14-16-year-old girls had started the vaccination schedule and 22.9% were fully vaccinated. VC for ≥1 dose had decreased between 2009 and 2012 (-14 points in 14-year-old girls, -16 points in 15-year-old girls, and -11 points between 2009 and 2012 in 16-year-old girls). Regional VCs were heterogeneous. HPV VC is clearly insufficient. It is essential that physicians concerned by HPV vaccination be mobilized and take every opportunity to inform, reassure, and vaccinate teenage girls. HPV vaccination has been recommended for girls between 11 and 14years of age since 2013, which could help improve adherence to vaccination.
    Médecine et Maladies Infectieuses 12/2013; · 0.75 Impact Factor
  • D Gendrel, R Cohen
    Archives de Pédiatrie 12/2013; 20(12):1273-5. · 0.36 Impact Factor
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    ABSTRACT: Some children with chronic lung disease associated with mucociliary clearance impairment and chronic bronchial congestion develop, during their evolution, bronchial bacterial colonization and recurrent infections. Therefore, antibioprophylaxis (ABP) is proposed by pediatric pulmonology specialists. Although some children seem improved by this strategy, it is worthy to note that no pediatric study supports its effectiveness, and no guidelines from society currently recommend its prescription. Demonstrated clinical benefits of ABP involve rare and highly targeted diseases. These children require a specialized assessment before any decision of ABP. Cystic fibrosis is definitely a situation where the interest of ABP is well established. By extension of the data obtained in adults, children with bronchiectasis (DDB) could potentially benefit from prolonged antibiotic therapy. In recurrent bacterial infections of the airways without DDB, ABP should be limited and restricted to most severe cases. In the absence of data on the benefit of alternate antibiotic treatment, we propose to focus on a single-molecule antibiotic prescribed for long periods. It may be amoxicillin, macrolides or cotrimoxazole. Furthermore, there is currently no data justifying the prescription of long-term macrolides in childhood asthma.
    Archives de Pédiatrie 11/2013; 20 Suppl 3:S99-S103. · 0.36 Impact Factor
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    ABSTRACT: Intra or extra orbital cellulitis or abscesses are the most frequent bacterial complications of acute sinusitis. Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus (SA), and anaerobic bacteria are predominant, and more rarelyHaemophilus influenzae (especially since vaccination against type b). Because of bacterial sensitivity, PK/PD parameters of antibiotics, and depending on the classification of Chandler, different probabilistic regimens may be proposed: In class 1 by Chandler (preseptal cellulitis), amoxicillinclavulinate (80mg/kg/d) in 2 oral doses, and ceftriaxone in intramuscular injection; in cases of class 2 to 5 by Chandler, high doses of intravenous amoxicillin-clavulinate (until 150mg/kg/d of amoxicillin), or intravenous association of ceftriaxone (100mg/kg/d) or cefotaxim (200mg/kg/d), with anti-anaerobic like metronidazole (30mg/kg/d) or clindamycine (40mg/kg/d).
    Archives de Pédiatrie 11/2013; 20 Suppl 3:e5-9. · 0.36 Impact Factor
  • R Cohen, E Grimprel
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    ABSTRACT: Azithromycin (AZM) has unique pharmacokinetic and pharmacodynamic characteristics that give it unusual clinical properties for an antibiotic. Gradually, potential indications have increased reaching a number of clinical situations, including pulmonary prophylaxis such as cystic fibrosis or bronchiectasis or chronic obstructive pulmonary diseases. However, the risks associated with its use are particularly concerning by selecting power that make AZM as real ecological time bomb. This should lead to only use AZM in situations where well-conducted clinical studies have demonstrated an indisputable superiority over standard treatment or placebo, and by limiting the number of patients treated.
    Archives de Pédiatrie 11/2013; 20 Suppl 3:S104-7. · 0.36 Impact Factor
  • R Cohen, I Hau, F Madhi
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    ABSTRACT: ENT and dental surgical procedures are the most common causes of surgery in children: the majority of them (adenoidectomy, tonsillectomy, trans-tympanic tubes, etc.) does not warrant antibiotic prophylaxis (ABP). When ABP is justified, it follows the general rules of surgical antibiotic prophylaxis: a molecule spectrum including the main bacterial targets (and possibly not used in curative treatment), short-term administration, a single injection 30 to 60 minutes before surgical incision. For cataracts, prophylaxis by intracameral cefuroxime must supplant the antibiotic therapy.
    Archives de Pédiatrie 11/2013; 20 Suppl 3:S79-82. · 0.36 Impact Factor
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    ABSTRACT: The French Group of Pediatric Infectious Diseases (PID) of the French Society of Pediatrics found necessary to issue in 2011 therapeutic proposals concerning antibiotic treatment in severe ENT infections in children (acute mastoiditis, severe sinusitis, peripharyngeal abscess). They took into account, for each clinical situation, published studies and existing guidelines, the most frequently encountered bacterial species, their usual sensitivity to antibiotics, their pharmacokinetic and pharmacodynamic (PK-PD) characteristics. These propositions aim to ensure the proper use of antibiotics and to limit the development of bacterial resistance to antibiotics by minimizing the use of broadspectrum molecules, especially cephalosporins and penems. These infections are often multi microbial and respond to aerobic flora similar to that found in non severe community acquired ENT infections and soft tissue infections ( Streptococcus pyogenes or group A Streptococcus(GAS), Streptococcus pneumoniae, Staphylococcus aureus and Haemophilus influenzae). Anaerobic flora may be associated and implicated in some situations. In most cases, high-dosage of amoxicillin +/- clavulanic acid offers the best PK/PD profile and allows to avoid the overuse of injectable third-generation cephalosporins.
    Archives de Pédiatrie 11/2013; 20 Suppl 3:e14-9. · 0.36 Impact Factor
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    ABSTRACT: In children, acute mastoiditis is a classic but rare complication of otitis media. Primary treatment of mastoiditis is mainly medical with intravenous antibiotics. Surgical procedures may be necessary for complicated forms of the disease. Though, the adequacy of the initial empiric antibiotic therapy with the susceptibility of the suspected bacteria germs is essential to avoid potentially serious complications. We perform a review of the literature to provide supportive arguments for the therapeutic approach of acute mastoiditis in children worked out by the French Group for Pædiatric Infectious Diseases.
    Archives de Pédiatrie 11/2013; 20 Suppl 3:e10-3. · 0.36 Impact Factor

Publication Stats

859 Citations
162.77 Total Impact Points

Institutions

  • 1987–2014
    • Centre Hospitalier Intercommunal Creteil
      Créteil, Île-de-France, France
  • 2013
    • French Institute of Health and Medical Research
      • Unit of Epidemiological Research on Perinatal Health and Woman's and Children's Health
      Paris, Ile-de-France, France
    • University of Lille Nord de France
      Lille, Nord-Pas-de-Calais, France
  • 2008–2009
    • Pierre and Marie Curie University - Paris 6
      Lutetia Parisorum, Île-de-France, France
    • Hôpital Jean-Verdier – Hôpitaux Universitaires Paris-Seine-Saint-Denis
      Bondy, Île-de-France, France
    • Centre Hospitalier de Versailles
      Versailles, Île-de-France, France
    • Centre Hospitalier Régional Universitaire de Lille
      Lille, Nord-Pas-de-Calais, France
    • Hôpital Saint-Vincent-de-Paul – Hôpitaux universitaires Paris Centre
      Lutetia Parisorum, Île-de-France, France
    • Paris Diderot University
      Lutetia Parisorum, Île-de-France, France
  • 2007
    • Hôpital Universitaire Robert Debré
      • Service de Pédiatrie Générale
      Lutetia Parisorum, Île-de-France, France
  • 2004
    • Kaiser Permanente
      Oakland, California, United States
  • 2000
    • Hôpital Louis-Mourier – Hôpitaux Universitaires Paris Nord Val de Seine
      Colombes, Île-de-France, France
  • 1994–1997
    • Computational Hydraulics Int.
      Guelph, Ontario, Canada
  • 1996
    • CHU de Lyon - Hôpital de la Croix-Rousse
      Lyons, Rhône-Alpes, France