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Archives de pédiatrie
Volume 21, n° 10
pages 1073-1078 (octobre 2014)
Doi : 10.1016/j.arcped.2014.06.027
Received : 22 December 2011 ;  accepted : 23 June 2014
Thrombopénie et nature des germes infectants en réanimation pédiatrique
Thrombopenia and the nature of the microorganism in infected critically ill children
 

M. Trifa a, , M.M. Ben Yahia a, S. Saada a, S. Akrout a, A. Ghlala a, R. Fakhfakh b, A. Fekih Hassen a, S. Ben Khalifa a
a Service d’anesthésie réanimation, faculté de médecine, université Tunis El Manar, hôpital d’enfants, Bab Saadoun, 1006 Tunis, Tunisie 
b Service d’épidémiologie et de médecine préventive, faculté de médecine, université Tunis El Manar, Tunis, Tunisie 

Auteur correspondant.
Résumé
Introduction

La thrombopénie est associée au sepsis et à la mortalité en milieu de réanimation pédiatrique. Le but de notre travail était de rechercher une association entre la thrombopénie et la nature des germes infectants afin de mieux guider le choix de l’antibiothérapie probabiliste chez l’enfant en réanimation.

Matériel et méthodes

Il s’est agi d’une étude prospective descriptive, incluant tous les nouveau-nés, nourrissons et enfants admis dans une unité de réanimation chirurgicale pédiatrique pendant une période d’1 an. Parmi eux, les patients ayant développé une infection (germe responsable et profil de résistance aux antibiotiques) ou une thrombopénie (nombre de plaquettes inférieur à 100 000/mm3) au cours de l’hospitalisation ont été identifiés.

Résultats

Cent quatre-vingt-dix-sept patients ont été inclus (28,9 % de nouveau-nés). Quatre-vingt-dix enfants ont développé 100 épisodes infectieux durant la période d’étude. Trente-quatre épisodes de thrombopénie ont été observés chez 30 enfants. Une thrombopénie n’a été observée que chez les enfants considérés comme infectés (p <0,001). La thrombopénie était associée à l’infection par bacilles à Gram négatif (p =0,001), due au genre Klebsiella (p =0,001). Il existait une tendance à l’association entre germes sécréteurs de β-lactamases à spectre élargi et thrombopénie (p =0,07).

Conclusion

En raison de la proportion assez importante de bacilles à Gram négatif présentant un profil de résistance étendue, une antibiothérapie probabiliste à large spectre, associant une carbapénème et un aminoside, pourrait être indiquée chez les enfants présentant un syndrome infectieux associé à une thrombopénie en milieu de réanimation.

The full text of this article is available in PDF format.
Summary
Background

Thrombopenia is correlated with sepsis and mortality in pediatric intensive care units. The purpose of this study was to find an association between thrombopenia and the microorganism type to guide the choice of empiric antibiotic therapy in infected critically ill children.

Materials and methods

We conducted a prospective descriptive study, including all newborns, infants, and children admitted to a pediatric surgical intensive care unit from 1st January to 31st December 2009. We identified patients who developed an infection and/or thrombopenia (platelet count less than 100,000/mm3) during hospitalization.

Results

One hundred ninety-seven patients were included (57 newborns, 41 infants, 99 children). Ninety patients developed 100 infectious episodes during the study period. Of the 57 newborns enrolled in the study, 31 (54%) developed 37 infections. Seventy-six microorganisms (55 Gram-negative bacilli [GNB], 17 Gram-positive cocci, two Gram-negative cocci, two fungal pathogens) were identified during 65 infectious episodes in 55 patients. Thirty-four episodes of thrombopenia were observed in 30 patients. Thrombopenia was observed only in infected patients (P <0.001). Thrombopenia was associated with infections caused by GNB (26/28 vs 20/37, P =0.001) and by Klebsiella (16/28 vs 6/37, P =0.001) and may be associated with infections caused by GNB producing extended-spectrum beta-lactamases (P =0.07). Gram-positive cocci infections were correlated to the non-occurrence of thrombopenia (P =0.02). Postoperative peritonitis was also significantly associated with thrombopenia (P =0.03). The mortality rate in our patients was 12.7% (22.8% in neonates). There was an association between thrombopenia and death in univariate analysis (11/25 vs 19/172, P <0.001). Multivariate logistic regression analysis did not confirm thrombopenia as an independent predictive factor of mortality in children.

Conclusion

Because of the relatively high proportion of resistant GNB, an empiric antibiotic therapy combining a carbapenem and an aminoglycoside may be indicated in infected critically ill children developing thrombopenia.

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