F. Dubos

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

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Publications (153)233.08 Total impact


  • No preview · Article · Dec 2015
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    ABSTRACT: Importance The procalcitonin (PCT) assay is an accurate screening test for identifying invasive bacterial infection (IBI); however, data on the PCT assay in very young infants are insufficient.Objective To assess the diagnostic characteristics of the PCT assay for detecting serious bacterial infection (SBI) and IBI in febrile infants aged 7 to 91 days.Design, Setting, and Participants A prospective cohort study that included infants aged 7 to 91 days admitted for fever to 15 French pediatric emergency departments was conducted for a period of 30 months (October 1, 2008, through March 31, 2011). The data management and analysis were performed from October 1, 2011, through October 31, 2014.Main Outcomes and Measures The diagnostic characteristics of the PCT assay, C-reactive protein (CRP) concentration, white blood cell (WBC) count, and absolute neutrophil cell (ANC) count for detecting SBI and IBI were described and compared for the overall population and subgroups of infants according to the age and the duration of fever. Laboratory test cutoff values were calculated based on receiver operating characteristic (ROC) curve analysis. The SBIs were defined as a pathogenic bacteria in positive culture of blood, cerebrospinal fluid, urine, or stool samples, including bacteremia and bacterial meningitis classified as IBIs.Results Among the 2047 infants included, 139 (6.8%) were diagnosed as having an SBI and 21 (1.0%) as having an IBI (11.0% and 1.7% of those with blood culture (n = 1258), respectively). The PCT assay offered an area under the curve (AUC) of ROC curve similar to that for CRP concentration for the detection of SBI (AUC, 0.81; 95% CI, 0.75-0.86; vs AUC, 0.80; 95% CI, 0.75-0.85; P = .70). The AUC ROC curve for the detection of IBI for the PCT assay was significantly higher than that for the CRP concentration (AUC, 0.91; 95% CI, 0.83-0.99; vs AUC, 0.77; 95% CI, 0.65-0.89; P = .002). Using a cutoff value of 0.3 ng/mL for PCT and 20 mg/L for CRP, negative likelihood ratios were 0.3 (95% CI, 0.2-0.5) for identifying SBI and 0.1 (95% CI, 0.03-0.4) and 0.3 (95% CI, 0.2-0.7) for identifying IBI, respectively. Similar results were obtained for the subgroup of infants younger than 1 month and for those with fever lasting less than 6 hours.Conclusions and Relevance The PCT assay has better diagnostic accuracy than CRP measurement for detecting IBI; the 2 tests perform similarly for identifying SBI in febrile infants aged 7 to 91 days.
    No preview · Article · Nov 2015
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    ABSTRACT: To distinguish children with chemotherapy-induced febrile neutropenia (FN) at low risk of severe infection, the variables that are significant risk factors must be identified. Our objective was to identify them by applying evidence-based standards. This retrospective 2-center cohort study included all episodes of chemotherapy-induced FN in children in 2005 and 2006. The medical history, clinical, and laboratory data available at admission were collected. Severe infection was defined by bacteremia, a positive culture of a normally sterile body fluid, invasive fungal infection, or localized infection at high risk of extension. Univariate analysis identified potential predictive variables. A generalized mixed model was used to determine the adjusted variables that predict severe infection. We analyzed 372 FN episodes. Severe infections occurred in 16.1% of them. Variables predictive of severe infection at admission were: disease with high risk of prolonged neutropenia (adjusted odds ratio [aOR]=2.5), blood cancer (aOR=1.9), fever ≥38.5°C (aOR=3.7), and C-reactive protein level ≥90 mg/L (aOR=4.5). Now that we have identified these variables significantly associated with the risk of severe infection, they must be validated prospectively before combining the best predictive variables in a decision rule that can be used to distinguish children at low risk.
    No preview · Article · Oct 2015 · Journal of Pediatric Hematology/Oncology
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    ABSTRACT: The impact of the 13-valent pneumococcal conjugate vaccine (PCV13) on the incidence of pneumococcal meningitis (PM) in children is unknown. To determine this impact, a descriptive multicentre retrospective cohort study was conducted from 2008 to 2013 in northern France. All laboratory-confirmed PM in children aged <18 years in all hospitals of the area with paediatric units were included. Two independent databases were used for exhaustive identification of cases: medical plus laboratory records at each hospital and discharge codes. The corrected incidence of PM was determined by a capture–recapture analysis using these two databases. Sixty-two cases were found over the 6-year period. A decrease of the PM corrected incidence was observed in the global population ( P = 0·07), significant only for children aged <2 years, from 11·9/100 000 in 2008 in 1·9/100 000 in 2013 [6·4 fold-decrease, 95% confidence interval (CI) 1·4–41, P = 0·01] between years 2008 and 2013. When comparing the pre- and post-PCV13 periods, this decrease was still statistically significant for children aged <2 years [7·32/100 000 (95% CI 4·39–10·25) to 2·78/100 000 (95% CI 0·96–4·60), P = 0·01]. Only three (5%) cases of PM caused by vaccine serotypes could have been prevented. After the introduction of the PCV13 vaccine, a decrease in the incidence of PM cases in children in northern France was observed.
    No preview · Article · Aug 2015 · Epidemiology and Infection
  • J Cohen · F Dubos · P Bossuyt · M Chalumeau · C Levy · A Martinot

    No preview · Article · May 2015 · Archives de Pédiatrie
  • D. Diallo · C. Santal · M. Lagrée · A. Martinot · F. Dubos

    No preview · Article · May 2015
  • A.C. Bailly · P. Gras · M. Lagrée · A. Martinot · F. Dubos

    No preview · Article · May 2015
  • A Martinot · F Dubos

    No preview · Article · May 2015 · Archives de Pédiatrie

  • No preview · Article · May 2015
  • F Angoulvant · F Dubos · R Cohen · A Martinot
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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.
    No preview · Article · Mar 2015 · Archives de Pédiatrie
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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.
    No preview · Article · Mar 2015 · PEDIATRICS
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    ABSTRACT: Évaluer la conformité de la prise en charge thérapeutique des enfants ayant eu une infection urinaire (IU) au protocole institutionnel du Centre hospitalier régional universitaire de Lille, dans le contexte d’augmentation des IU à entérobactéries productrices de bêta-lactamases à spectre étendu (BLSE).
    No preview · Article · Jan 2015 · Archives de Pédiatrie
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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.
    No preview · Article · Nov 2014
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    ABSTRACT: Background and aim 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 analyse the derivation methods and validation procedures of these CDRs. Methods 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 analysed 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.
    Full-text · Article · Oct 2014 · Pediatric Blood & Cancer
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    ABSTRACT: Aim To evaluate the initial management of children with parapneumonic effusion admitted to all French university hospitals. Methods A nationwide survey of all university hospitals (n = 35) took place in 2011 to assess practices for children with parapneumonic effusion, through a hypothetical clinical vignette and a standardized questionnaire. Two to four paediatricians per hospital were interviewed and asked about their initial management, probabilistic antibiotic therapy and its adaptation to microbiological results, additional treatment, and action in the absence of improvement. Answers of paediatricians working in emergency departments, intensive care units, and conventional paediatric units were compared. Results Of the 100 paediatricians contacted, 95 responded: 98% would order an initial blood test, and 70% diagnostic thoracentesis. All would start immediate antibiotic therapy: 31% with a single drug, 67% with 2 drugs, and 2% with 3 drugs. The most frequent initial choices were third-generation cephalosporin alone (17%) or combined with rifampicin (33%) or vancomycin (24%). Adaptation varied according to drug used, dose, and duration, especially when the microorganism was not S. pneumoniae. Practices did not differ significantly among the different groups of paediatricians. Conclusion Standardized management of parapneumonic effusion, including routine thoracentesis and more consistent prescription of antibiotics, is needed.
    No preview · Article · Oct 2014 · Archives of Disease in Childhood
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    ABSTRACT: Background The incidence of childhood bone and joint infections (BJIs) is not well known, but is useful for identifying epidemiological differences and improving practice. Objective To determine the incidence of BJI in previously well children and describe their clinical, laboratory and radiological characteristics. Design A multicentre, population-based, prospective study performed from July 2008 through June 2009. Setting Region of northern France with a population of 872 516 children <16 years old. Patients All previously well children admitted in the region with septic arthritis, acute osteomyelitis or spondylodiscitis, diagnosed according to consensus criteria and after blinded radiological review. Main outcome measures The corrected incidence of BJI, determined with a capture-recapture method that used this prospective database and the discharge summary database. Results 58 cases were identified (median age: 3.6 years, range: 1 month–15.8 years; male to female ratio: 1.6). The completeness of the prospective database was 90%. The corrected incidence of any BJI was 7.1/100 000 children (95% CI 5.3 to 8.9). Thirty patients had septic arthritis (52%, incidence: 3.7/100 000; 95% CI 2.4 to 4.9), 24 osteomyelitis (41%, incidence 3.0/100 000; 95% CI 1.8 to 4.1), 4 spondylodiscitis (7%) and 0 osteoarthritis. Micro-organisms were identified from 15 patients (26%), with Staphylococcus aureus the most frequent organism. Radiological findings were characteristic of infection in 44% of BJI. Conclusions The corrected incidence of BJI in northern France, according to consensus diagnostic criteria, was 7.1/100 000 children <16 years of age.
    No preview · Article · Sep 2014 · Archives of Disease in Childhood
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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.
    No preview · Article · Aug 2014 · Archives de Pédiatrie
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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.
    Full-text · Article · May 2014 · Acta Orthopaedica
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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.
    No preview · Article · May 2014 · Acta paediatrica (Oslo, Norway: 1992). Supplement

  • No preview · Article · May 2014 · Archives de Pédiatrie

Publication Stats

873 Citations
233.08 Total Impact Points

Institutions

  • 2008-2015
    • Centre Hospitalier Régional Universitaire de Lille
      Lille, Nord-Pas-de-Calais, France
    • Université du Droit et de la Santé Lille 2
      Lille, Nord-Pas-de-Calais, France
    • Hôpital Jean-Verdier – Hôpitaux Universitaires Paris-Seine-Saint-Denis
      Bondy, Île-de-France, France
  • 2007-2015
    • Lille Catholic University
      Lille, Nord-Pas-de-Calais, France
    • University of Lille Nord de France
      Lille, Nord-Pas-de-Calais, France
  • 2006-2010
    • Université René Descartes - Paris 5
      • Faculty of medicine
      Lutetia Parisorum, Île-de-France, 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