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Résumé Le rotavirus est la cause la plus fréquente de gastro-entérite (GEA) nécessitant une hospitalisation chez l’enfant. C’est un virus très résistant et contagieux à l’origine de nombreuses GEA nosocomiales (GEAN). En France, le vaccin contre le rotavirus est disponible depuis 2006, mais il n’est pas recommandé. Le but de cette étude rétrospective était de décrire les GEAN à rotavirus et d’évaluer leur incidence chez les enfants hospitalisés dans le service de pédiatrie générale de l’hôpital Robert-Debré (Paris) entre le 1 er janvier 2009 et le 31 décembre 2013. Nous avons évalué si ces enfants auraient pu bénéficier de la vaccination contre le rotavirus. Résultats Au total, 136 enfants ont présenté une GEAN à rotavirus, soit une incidence de 2,5 cas pour 1000 jours d’hospitalisation. Cette incidence est restée stable entre 2009 et 2013 malgré le renforcement des mesures d’hygiène. L’âge moyen des enfants était de 7 mois (entre 0,5 et 111 mois). Les GEAN à rotavirus étaient survenues chez des enfants hospitalisés le plus souvent pour une pathologie respiratoire aiguë (65 %) et nécessitant une hospitalisation prolongée (médiane = 18 jours). Un quart des enfants étaient nés prématurés (25 %). L’hydratation a été orale pour 80 enfants (59 %), par perfusion intraveineuse pour 18 (13 %) et par voie intra-osseuse pour 1 enfant. La moitié des patients était âgée de moins de 5 mois et aurait pu bénéficier de la protection fournie par la vaccination. Conclusion Les GEAN rotavirus sont fréquentes. La vaccination des nourrissons contre le rotavirus permettrait de diminuer les hospitalisations pour gastro-entérite communautaire à rotavirus et, indirectement, de protéger les enfants porteurs de pathologies sous-jacentes trop jeunes pour être vaccinés. Summary Rotavirus is the most common cause of gastroenteritis in children requiring hospitalization. It is a very resistant and contagious virus causing nosocomial gastroenteritis. In France, the vaccine against rotavirus has been available since 2006, but the vaccine is not recommended for infant vaccination. The aim of this retrospective study was to describe nosocomial rotavirus gastroenteritis (NRGE) and to assess its impact on children hospitalized in the General Pediatrics Department of Robert-Debré Hospital (Paris) between 1 January 2009 and 31 December 2013. We analyzed the demographic characteristics of children (age, term birth, underlying diseases) and the severity of the NRGE (oral or intravenous hydration), and assessed whether these children could benefit from vaccination against rotavirus. Results One hundred thirty-six children presented nosocomial rotavirus infection, with an incidence of 2.5 NRGE per 1000 days of hospitalization. The incidence of NRGE was stable between 2009 and 2013 despite the introduction of specific hygiene measures. The average age of the children was 7 months (range: 0.5–111 months). Most often NRGE occurred in children hospitalized for respiratory diseases (65% of cases) and requiring prolonged hospitalization (median: 18 days). One-third of children were born premature (25%). Hydration was oral in 80 patients (59%), by intravenous infusion in 18 patients (13%), and intraosseous in one patient. Half of the patients were aged less than 5 months and could benefit from the protection afforded by vaccination. Conclusion NRGE are common. Rotavirus mass vaccination should have a positive impact on the incidence of NRGE by reducing the number of children hospitalized for gastroenteritis, therefore indirectly reducing the number of hospital cross-infections of hospitalized children who are too young to be vaccinated. [ABSTRACT FROM AUTHOR]

Abstract: In this study, the authors report the distribution of serogroups/serotypes and their susceptibility profiles of Streptococcus pneumoniae causing recurrent and difficulties to treat acute otitis media (AOM) in children obtained at the ENT outpatient clinic of Robert Debré Hospital in Paris, between 2002–2008 after the implementation of the 7-valent pneumococcal conjugate vaccine. In this retrospective study, 126 S. pneumoniae isolates were obtained by tympanocentesis from 126 children with AOM during three different periods: 2002–2003 (period 1), 2004–2005 (period 2), and 2006–2008 (period 3). In period 1, the most common serotype was 19F. Between period 1 and period 3, the proportion of serotype 19F decreased from 39 to 13% (P =0.03). In contrast, the proportion of serotype 19A increased from 25 to 60% (P =0.03). So, they observed that vaccine-related serotype 19A became dominant among young children with AOM in 2006–2008. Overall, 15.1% of the isolates were penicillin susceptible, 73.8% intermediate and 11.1% were resistant. Most (94%) of the S. pneumoniae serotype 19A were penicillin intermediate. [Copyright &y& Elsevier]

L’antibiothérapie empirique de l’angine à Streptococcus pyogenes (SGA) repose sur des études épidémiologiques de la résistance aux antibiotiques. Le but de notre étude a été d’évaluer l’activité de différents antibiotiques (pénicilline G, amoxicilline, érythromycine, clarithromycine et clindamycine) vis-à-vis de 206 souches de SGA isolées d’angines aiguës de l’enfant entre 2002 et 2004. Les CMI 50 et 90 de l’érythromycine, la clarythromycine et la clindamycine ont été déterminées sur les 100 premières souches par la méthode de dilution en milieu gélosé (CA-SFM). Les gènes de résistance aux macrolides (ermA, ermB, mef) ont été recherchés par PCR sur les souches résistantes aux macrolides.Aucune résistance vis-à-vis des ß-lactamines n’a été observée. En revanche, notre étude met en évidence l’émergence de la résistance aux macrolides chez SGA avec une prévalence de la résistance à l’érythromycine et à la clarythromycine de 14,5 % et de 12,6 % à la clindamycine. Les gènes ermB et mefA ont été retrouvés chez respectivement 13,5 et 1 % des souches, leur conférant ainsi le phénotype MLSB ou M. [Copyright &y& Elsevier]

Abstract: Management of bone and joint infections in children associates early appropriate antibiotic therapy against Staphylococcus aureus and Kingella kingae and, if necessary, surgical drainage of abscess or septic arthritis. In 2007, the Paediatric Infectious Diseases Group of the French Society of Paediatrics (GPIP) proposed guidelines for antibiotherapy in acute and non-complicated cases, with an intravenous therapy during 4 to 7days followed by oral therapy during 3weeks. [Copyright &y& Elsevier]

Summary: Extended-spectrum beta-lactamase (ESBLs) are defined as β-lactamase capable of hydrolyzine oximino-cephalosporins and aztreonam and are encododed by mobile genes. The most frequently encountered ESBLs belong to the CTX-M, SHV, and TEM families. ESBLs were found first in Klebsiella pneumonia and then predominantly in E. coli. The incidence of patients with ESBLs E. coli increase since 2000 in Robert Debré Hospital. They were responsible of cystitis or pyelopnephritis and rarely of materno-foetal infections or neonatal meningitis. These strains were susceptible to colimycin, carbapenems and fosfomycin. [Copyright &y& Elsevier]

Objectif: décrire les caractéristiques cliniques et microbiologiques des infections ostéo-articulaires (IOA) àStreptococcus pneumoniae (Sp) chez l’enfant. Méthode: étude rétrospective concernant les enfants < 16 ans hospitalisés pour une IOA à pneumocoque entre 1997 et 2007 dans 4 hôpitaux. Résultats: 43 enfants inclus : 32 arthrites, 7 ostéomyélites et 4 ostéo-arthrites. Age médian = 12,5 mois (3 mois à 14 ans). 7/39 enfants étaient vaccinés par le vaccin pneumococcique conjugué à 7 valences. 35/43 souches de Sp (58 %) étaient intermédiaires ou résistantes à la pénicilline. 19 sérotypes ont été identifiés: sérotypes 19A (n = 7, 40 %), 14 (n = 5), 1 (n = 2), 6A (n = 1), 6B (n = 1), 9 (n = 1), 15B (n = 1) et 20 (n = 1). Des sérotypes vaccinaux ont été isolés chez 3 enfants non vaccinés et chez un enfant ayant reçu une seule dose vaccinale. Un seul échec vaccinal a été retrouvé impliquant une souche de sérotype 14, 3 infections avec du sérotype 19A sont survenues chez 3 enfants correctement vaccinés. L’évolution a été favorable pour l’ensemble des patients. 5 enfants ont nécessité une reprise chirurgicale : 3 récidives d’arthrite, 1 abcès sous périosté, 1 péritonite dont 2 impliquaient un sérotype 1. Conclusion: Les IOA à Sp sont rares et surviennent majoritairement chez des enfants < 2ans. [ABSTRACT FROM AUTHOR]

Abstract: Since the 1980s, infections due to Streptococcus pyogenes or group A streptococci (GAS) were marked by the increase in invasive infections and the emergence of clones which were resistant to macrolides. Those challenges led the French national reference center for streptococci to enhance the epidemiological survey and the characterization of GAS strains, in collaboration with the National Institute for Public Health Surveillance. Active surveillance is of major importance for implementation of therapeutic and prophylactic guidelines and for evaluation of future streptococcal vaccines. [Copyright &y& Elsevier]

Objectifs Décrire les infections ostéoarticulaires (IOA) des nourrissons de moins de 3 mois. Matériels et méthodes Les données ont été collectées rétrospectivement chez tous les enfants âgés de moins de 3 mois hospitalisés pour une IOA sur une période de 11 ans (2004–2015) dans les CHU Debré, Trousseau et Necker (Paris). Résultats Au total, 71 enfants ont été inclus avec un sexe ratio (M/F) de 1,4 et un âge médian de 25 jours [0–90] ; 11 enfants (15,4 %) étaient prématurés, 11 avaient une IOA nosocomiale. Les atteintes les plus fréquentes étaient la hanche (32 % des enfants) et le genou (32 %). Les symptômes étaient la douleur (94 %), l’impotence fonctionnelle (87 %), la fièvre (52 %). Le délai diagnostique médian était de 2 jours [0–15]. Un germe a été identifié chez 51 enfants (72 %) : Streptocoque du groupe B (45 % des germes), S. aureus (23,5 %), E. coli (17,6 %). La CRP médiane initiale était de 31 mg/L [1–226]. Cinq patients (sur 34 avec suivi > à 1 an) ont présenté des séquelles orthopédiques, dont : inégalité de longueur de membre ( n = 3), épiphysiodèse ( n = 2), ostéonécrose ( n = 1). Conclusion Le streptocoque du groupe B est le germe le plus fréquent dans les IOA communautaires du moins de 3 mois. Les séquelles orthopédiques peuvent être sévères justifiant un suivi orthopédique prolongé. [ABSTRACT FROM AUTHOR]

Objectif Décrire les infections ostéo-articulaires (IOA) des nourrissons de moins de 3 mois. Patients et méthodes Les données ont été collectées rétrospectivement chez tous les enfants âgés de moins de 3 mois hospitalisés pour une IOA sur une période de 11 ans (2004–2015) dans les CHU Debré, Trousseau et Necker (Paris). Résultats Au total, 71 enfants ont été inclus avec un sex-ratio (M/F) de 1,4 et un âge médian de 25 jours [0–90] ; 11 enfants (15,4 %) étaient prématurés, 11 avaient une IOA nosocomiale. Les atteintes les plus fréquentes étaient la hanche (32 % des enfants) et le genou (32 %). Les symptômes étaient la douleur (94 %), l’impotence fonctionnelle (87 %), la fièvre (52 %). Le délai diagnostique médian était de 2 jours [0–15]. Un germe a été identifié chez 51 enfants (72 %) : Streptocoque du groupe B (45 % des germes), S. aureus (23,5 %), E. coli (17,6 %). La CRP médiane initiale était de 31 mg/L [1–226]. Cinq patients (sur 34 avec suivi > 1 an) ont présenté des séquelles orthopédiques, dont : inégalité de longueur de membre ( n = 3), épiphysiodèse ( n = 2), ostéonécrose ( n = 1). Conclusion Le streptocoque du groupe B est le germe le plus fréquent dans les IOA communautaires du moins de 3 mois. Les séquelles orthopédiques peuvent être sévères justifiant un suivi orthopédique prolongé. [ABSTRACT FROM AUTHOR]

Summary: Background: Acute bacterial parotitis is a rare infectious disease in infants under 3months of age. Objectives: To describe the clinical characteristics and the course of acute bacterial parotitis in infants less than 3months old. Patients and methods: Infants under 3months of age, hospitalized at Robert Debré university hospital, Paris, France, between January 2005 and December 2009 for acute bacterial parotitis, were included in a retrospective study. Results: Five infants less than 3months of age were included in this study, for a frequency of 2.5/1000 hospitalizations in this age group. All were born at term, 4 of 5 were male. Three of the 5 patients had specific clinical signs of parotitis on admission. One patient had septic shock on admission. The ultrasound confirmed the parotitis in all cases. No parotid abscess was demonstrated on imaging. All patients had at least one abnormal inflammatory biological test (WBC, CRP, PCT). Bacteria were identified in 4 of 5 cases: Staphylococcus aureus was isolated in the pus culture of the Stenon duct in 2 patients and a group B Streptococcus was isolated from blood culture of 2 other patients. The duration of intravenous antibiotic therapy varied from 4 to 13days, and the total duration of antibiotic therapy was between 10 and 16days. No surgical procedures were needed. Conclusion: Acute bacterial parotitis in infants under 3months of age might be associated with localized infections due to S. aureus, but also with a more severe clinical presentation due to group B streptococcus infection. Early diagnosis and appropriate antibiotic therapy might prevent the progression to serious complications. [ABSTRACT FROM AUTHOR]

Summary: The healthy carrier of Streptococcus pneumoniae (S. pneumoniae) has been studied very little at the national level. With the emergence of antibiotic-resistant strains worldwide, and the emergence of new serotypes, an epidemiological survey is needed before the vaccine can be introduced in Morocco. Objectives: This study''s objective was to determine the prevalence and risk factors of pneumococcal nasopharyngeal carriage in children less than 2years of age in the Marrakech region and to assess the antibiotic susceptibility of the isolates and the serotypes present prior to the introduction of the conjugate pneumococcal vaccine. Patients and methods: From 2008 to 2009, 660 nasopharyngeal samples were collected on children under 2years of age during scheduled visits to dispensaries for routine immunization in the Marrakech region. Results: S. pneumoniae carriage was found in 45.8% of children. Of the 660 samples, 302 strains were isolated. The percentage of pneumococcal strains with reduced susceptibility to penicillin (PRSP) was 34.7%. Among these strains, 87.1% showed low-level resistance and 12.9% high-level resistance. Resistance to amoxicillin was found in 3.3% of the strains and no strains were resistant to cefotaxime. Several risk factors for pneumococcal carriage were identified, the main ones being breastfeeding less than 2 months, the presence of more than one sibling, passive smoking, and low socioeconomic level. The most frequent serotypes were 19F, 6, 14, 23, 18, and 9. The study of the vaccine serotype distribution showed that the theoretical vaccine coverage of the 7 valent vaccines was at 57% for all the isolates. Conclusion: These data show the frequency and the risk factors on nasopharyngeal carriage, and report the status of penicillin resistance of strains carrying children less than 2years of age in the Marrakech region. The fluctuation of circulating serotypes at the national level underscores the importance of epidemiological surveillance carried out before the introduction of the heptavalent vaccine in Morocco. [ABSTRACT FROM AUTHOR]

Dans le cadre de ses missions de contrôle des produits de santé, l''Afssaps en collaboration avec deux autres sites experts, a réalisé une évaluation des 16 tests de diagnostic rapide (TDR) des angines à Streptocoque A présents sur le marché français en 2002. Cette étude a été réalisée dans un but de surveillance du marché afin de s''assurer du caractère fiable et rapide de ces TDR et a eu pour objectif de préciser certaines caractéristiques analytiques et pratiques de ces réactifs. L''étude analytique a été réalisée sur un même panel de dilutions de quatre souches de référence de Streptococcus pyogenes afin de déterminer dans les mêmes conditions méthodologiques le seuil de détection de tous les réactifs. Les seuils de détection ont été calculés à partir des résultats exprimés en unités formant colonie par ml (UFC/ml). L''étude de praticabilité a permis d''analyser la qualité de leur présentation, la facilité de lecture et de réalisation des tests. Un score a été établi pour chacun des réactifs. Une classification de ces 16 dispositifs en termes de sensibilité analytique (seuil de détection) et praticabilité (score) a été réalisée. En ce qui concerne la sensibilité analytique, les réactifs les plus performants sont ceux qui présentent les seuils permettant de détecter la plus faible concentration bactérienne à savoir 105 UFC/ml. En terme de praticabilité, il apparaît que les techniques immunochromatographiques sur bandelettes sont les mieux classées dans une utilisation en dehors d''un laboratoire d''analyses de biologie médicale. [Copyright &y& Elsevier]

Summary: Aims: The objective of this study was to determine the incidence of extended-spectrum beta-lactamase (ESBLS) enterobacteriaceae colonization and infection in hospitalized children. Methods: This prospective study was conducted in a neonatal intensive care unit from 2000 to 2009. We recorded all isolations of ESBLs enterobacteriaceae from clinical samples that were obtained from hospitalized children. Anorectal samples were taken at admission and every 10 days. We systematically recorded cases of confirmed infections that was caused by ESBLs enterobacteriacea. Results: A total of 46 ESBLS pathogens (E coli 58.7 %, Enterobacter cloacae 10.8 %, Klebsiella Pneumonia 19.5%, K. oxytoca 6.5 %, Citrobacter 4.5 %) were isolated during 10 years, the global incidence was 5.1 cases per 1000 admissions. Three infants developed nosocomial infections, E. coli sepsis and pneumonia and Enterobacter cloacae omphalitis. These patients were treated with carbapenem with significant clinical improvement. ESBLs enterobacteriaceae were found first in Klebsiella pneumonia and then predominantly in E. coli. Current efforts have focused on monitoring proper hand hygiene, evaluation of potential reservoirs of bacterial acquisition and transmission, cohorting and isolation of colonized infants, and fostering of effective inter- and intrahospital communication. Carbapenem seems to be safe in newborn and is recommended for the treatment of EBLSEs enterobacteriaceae infections. [Copyright &y& Elsevier]

Rotavirus is the most common cause of gastroenteritis in children requiring hospitalization. It is a very resistant and contagious virus causing nosocomial gastroenteritis. In France, the vaccine against rotavirus has been available since 2006, but the vaccine is not recommended for infant vaccination. The aim of this retrospective study was to describe nosocomial rotavirus gastroenteritis (NRGE) and to assess its impact on children hospitalized in the General Pediatrics Department of Robert-Debré Hospital (Paris) between 1 January 2009 and 31 December 2013. We analyzed the demographic characteristics of children (age, term birth, underlying diseases) and the severity of the NRGE (oral or intravenous hydration), and assessed whether these children could benefit from vaccination against rotavirus., Results: One hundred thirty-six children presented nosocomial rotavirus infection, with an incidence of 2.5 NRGE per 1000 days of hospitalization. The incidence of NRGE was stable between 2009 and 2013 despite the introduction of specific hygiene measures. The average age of the children was 7 months (range: 0.5-111 months). Most often NRGE occurred in children hospitalized for respiratory diseases (65% of cases) and requiring prolonged hospitalization (median: 18 days). One-third of children were born premature (25%). Hydration was oral in 80 patients (59%), by intravenous infusion in 18 patients (13%), and intraosseous in one patient. Half of the patients were aged less than 5 months and could benefit from the protection afforded by vaccination., Conclusion: NRGE are common. Rotavirus mass vaccination should have a positive impact on the incidence of NRGE by reducing the number of children hospitalized for gastroenteritis, therefore indirectly reducing the number of hospital cross-infections of hospitalized children who are too young to be vaccinated., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Septic arthritis has to be suspected in children with joint effusion and fever so as to perform joint aspiration, which will confirm the diagnosis by bacteriological methods, and to perform surgical treatment by joint lavage. Since development of current molecular methods, such as real-time PCR, Kingella kingae has become the first microbial agent of osteoarticular infections in young children, whereas Staphylococcus aureus is second. C-reactive protein (CRP) is an aid used to diagnose septic arthritis, but its elevation could be moderate. In a previous study, conducted at our hospital, 10% of children hospitalized for S. aureus or K. kingae septic arthritis had a CRP level<10 mg/L. To determine if diagnosis of septic arthritis could be made by other parameters, we analyzed the clinical and biologic features of these patients and compared them to those of children hospitalized for septic arthritis with initial CRP ≥10 mg/L. Among the 89 children with septic arthritis, 10% (n=9) had initial CRP<10 mg/L (K. kingae, n=5/63 ; S. aureus, n=4/26). Initial temperature and fibrinogen were significantly lower in the CRP<10 mg/L group than in the other (37.3°C vs. 37.9°C, P=0.039 and 4.19 vs. 5.72 g/L, P=0.003, respectively). Age, symptom duration before diagnosis, as well as leukocyte and platelet counts were similar in both groups. Two children (2/89=2.2%) with S. aureus septic arthritis had no fever, CRP elevation, or fibrinogen elevation. In the CRP-negative group, three of four children with S. aureus arthritis and one of five with K. kingae arthritis had a high CRP level (34, 40, 61, and 13 mg/L, respectively) 3 days after surgery and antibiotic treatment. One child with K. kingae septic arthritis and initial CRP<10 mg/L needed a second surgical drainage because of relapse of arthritis. In the S. aureus arthritis group, none of the children with initial CRP<10 mg/L experienced complications, while six of those with initial CRP≥10 mg/L needed a second surgical act or hospitalization in an intensive care unit. While CRP is most often>10 mg/L during septic arthritis in children, it could be negative in up to 20% of patients in different studies. However, a mild inflammatory syndrome or even a CRP<10 mg/L cannot exclude diagnosis of septic arthritis. Therefore, a first episode of monoarthritis in children has to be considered as septic arthritis and treatment should not be delayed., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

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., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Background: Acute bacterial parotitis is a rare infectious disease in infants under 3 months of age., Objectives: To describe the clinical characteristics and the course of acute bacterial parotitis in infants less than 3 months old., Patients and Methods: Infants under 3 months of age, hospitalized at Robert Debré university hospital, Paris, France, between January 2005 and December 2009 for acute bacterial parotitis, were included in a retrospective study., Results: Five infants less than 3 months of age were included in this study, for a frequency of 2.5/1000 hospitalizations in this age group. All were born at term, 4 of 5 were male. Three of the 5 patients had specific clinical signs of parotitis on admission. One patient had septic shock on admission. The ultrasound confirmed the parotitis in all cases. No parotid abscess was demonstrated on imaging. All patients had at least one abnormal inflammatory biological test (WBC, CRP, PCT). Bacteria were identified in 4 of 5 cases: Staphylococcus aureus was isolated in the pus culture of the Stenon duct in 2 patients and a group B Streptococcus was isolated from blood culture of 2 other patients. The duration of intravenous antibiotic therapy varied from 4 to 13 days, and the total duration of antibiotic therapy was between 10 and 16 days. No surgical procedures were needed., Conclusion: Acute bacterial parotitis in infants under 3 months of age might be associated with localized infections due to S. aureus, but also with a more severe clinical presentation due to group B streptococcus infection. Early diagnosis and appropriate antibiotic therapy might prevent the progression to serious complications., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Unlabelled: The healthy carrier of Streptococcus pneumoniae (S. pneumoniae) has been studied very little at the national level. With the emergence of antibiotic-resistant strains worldwide, and the emergence of new serotypes, an epidemiological survey is needed before the vaccine can be introduced in Morocco., Objectives: This study's objective was to determine the prevalence and risk factors of pneumococcal nasopharyngeal carriage in children less than 2 years of age in the Marrakech region and to assess the antibiotic susceptibility of the isolates and the serotypes present prior to the introduction of the conjugate pneumococcal vaccine., Patients and Methods: From 2008 to 2009, 660 nasopharyngeal samples were collected on children under 2 years of age during scheduled visits to dispensaries for routine immunization in the Marrakech region., Results: S. pneumoniae carriage was found in 45.8% of children. Of the 660 samples, 302 strains were isolated. The percentage of pneumococcal strains with reduced susceptibility to penicillin (PRSP) was 34.7%. Among these strains, 87.1% showed low-level resistance and 12.9% high-level resistance. Resistance to amoxicillin was found in 3.3% of the strains and no strains were resistant to cefotaxime. Several risk factors for pneumococcal carriage were identified, the main ones being breastfeeding less than 2 months, the presence of more than one sibling, passive smoking, and low socioeconomic level. The most frequent serotypes were 19F, 6, 14, 23, 18, and 9. The study of the vaccine serotype distribution showed that the theoretical vaccine coverage of the 7 valent vaccines was at 57% for all the isolates., Conclusion: These data show the frequency and the risk factors on nasopharyngeal carriage, and report the status of penicillin resistance of strains carrying children less than 2 years of age in the Marrakech region. The fluctuation of circulating serotypes at the national level underscores the importance of epidemiological surveillance carried out before the introduction of the heptavalent vaccine in Morocco., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Since the 1980s, infections due to Streptococcus pyogenes or group A streptococci (GAS) were marked by the increase in invasive infections and the emergence of clones which were resistant to macrolides. Those challenges led the French national reference center for streptococci to enhance the epidemiological survey and the characterization of GAS strains, in collaboration with the National Institute for Public Health Surveillance. Active surveillance is of major importance for implementation of therapeutic and prophylactic guidelines and for evaluation of future streptococcal vaccines., (Copyright 2009 Elsevier Masson SAS. All rights reserved.)

Rotavirus is the major cause of gastroenteritis in children and the main cause of hospital acquired-infection in paediatric unit. We report the epidemiology of gastroenteritis in our hospital during five consecutive years. Rotavirus was involved in 13% of the patients. Seasonal peaks were observed in January and 45.8% of the patients were less than 6 month old. The rotavirus infection was hospital-acquired in 1/3 of the cases. During the winter period, the incidence of rotavirus nosocomial infection was 4.4%.

Within the scope of its health products control mission, the French Health Products Safety Agency (Afssaps) collaborating with two expert's sites, has assessed the 16 tests available on the French market in 2002 for rapid diagnosis of the Streptococcus A tonsillitis. The purpose of this study was to verify the reliability and rapidity of these tests and to give some information to the users about their analytical criteria and practicability characteristics. The analytical study has been performed on a same panel of four reference strains of Streptococcus pyogenes dilutions to determine the limit of detection of all the reagents in the same condition of methodology. The limit of detection has been calculated with the results expressed in colony forming unit by ml (CFU/ml). The practicability study has permitted to analyze the quality of the presentation, the easiness of the final reading and of performing tests. A score has been established for each rapid test. A classification of the analytical sensitivity (limit of detection) and practicability (score) of these 16 devices has been established. The limit of detection of the reagents giving the best results allows the detection of the lowest bacterial concentration of the panel which is 10(5) CFU/ml. Regarding practicability, the results suggest that, the immunochromatographic strip methods have the best score in a view with the use by a non medical laboratory.

Objective: Current guidelines recommend that only tonsillopharyngitis due to group A beta-haemolytic streptococcus (GABHS) diagnosed by rapid diagnostic test should be treated with antibiotics. Empirical antibiotic therapy must be based on epidemiological surveillance of resistance of GABHS to antibiotics. The aim of our study was to assess the activity of antimicrobial agents currently recommended for the treatment of GABHS tonsillopharyngitis. Method The activity of penicillin G, amoxicillin, cefaclor, cefpodoxime, cefuroxime, erythromycin, clarithromycin and clindamycin was determined against 93 consecutive GABHS isolates collected in 2002. MIC50 and MIC90 of antibiotics tested were determined by agar dilution method according to CA-SFM guidelines. Macrolide resistance genes (ermA, ermB, mef) were detected by PCR. Genetic diversity of erythromycin-resistant isolates was analysed by pulsotypic method after digestion by SmaI (Finger-printing II, Biorad)., Results: The activity of beta-lactam agents tested was similar and no resistant strain was detected (0%). Nevertheless, this study shows an increasing emergence of erythromycin-resistant GABHS strains reaching 14% in 2002 (vs. 6.2% in a previous study carried out in 1996-1999)., Conclusion: The empirical antibiotic therapy of tonsillopharyngitis must consider, on the one hand, the high risk of GABHS eradication failure associated with in vitro resistance to erythromycin and clarithromycin, and on the other hand, the sustained susceptibility of GABHS to beta-lactam agents. These results reinforce the recommendations to use beta-lactam agents as first line treatment of GABHS tonsillopharyngitis.

EPIDEMIOLOGY OF THE BACTERIA RESPONSIBLE: Acute otitis media (AOM) is the most common bacterial infection in childhood below the age of 5 years. Bacteria may be isolated from middle ear fluid in about two-thirds of patients. The prevalence of bacteria varies from one country to the next. The most common pathogens recovered are Streptococcus pneumoniae, Haemophilus influenzae (20-50%) and less frequently Moraxella catarrhalis (10%). However, several recent reports suggest an increasing rate of isolation of M. catarrhalis approaching 20%. Concomitant isolation of two or more organisms occurs in up to 10% of cases. The role of Group A Streptococci and Staphylococcus aureus in AOM has decreased since the use of antibiotics. EPIDEMIOLOGY OF ANTIMICROBIAL RESISTANCE: The recent spread of penicillin resistant S. pneumoniae and amoxycillin resistant H. influenzae varies considerably from one country to an other and appears related to the use of antibiotics and socio-economic conditions. A follow up of bacterial epidemiology and antibiotic resistance is necessary in each region of the world to define accurate strategies of acute otitis antibiotherapy.