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Resume Objectifs Le choix des antibiotiques (ATB) dans l’otite moyenne aigue (OMA) repose en partie sur la connaissance du niveau de resistance des bacteries responsables d’OMA. Le but de ce travail est d’evaluer en France dans une population d’enfants vaccines par le vaccin pneumococcique conjugue 7 valent (PCV7) et presentant une OMA, la resistance aux ATB des pneumocoques et des H. influenzae isoles de la flore rhinopharyngee. Methodes De 2006 a 2010, 66 pediatres ont realise des prelevements rhinopharynges chez des enfants de six a 24 mois presentant une OMA. Les caracteristiques demographiques, les antecedents, le statut vaccinal et la symptomatologie ont ete renseignes par les pediatres et transmis a ACTIV. Resultats Parmi les 3501 enfants inclus (moyenne d’âge 13,5 ± 5 mois), plus de 98 % etaient vaccines par le PCV7 et 41,1 % etaient gardes en creche. Dans 47,3 % des cas, un ATB avait ete recu dans les trois mois precedant l’inclusion (cephalosporines, 22,6 % ; amoxicilline acide clavulanique, 19,2 %). Ces enfants etaient porteurs de pneumocoque dans 57,9 % des cas et d’ H. influenzae dans 48,2 % des cas. Les souches de pneumocoque de sensibilite diminuee a la penicilline (PSDP) representaient 46,3 % des cas de S. pneumoniae (3,9 % de souches resistantes et 42,4 % de souches de sensibilite intermediaire) et les facteurs qui augmentaient le risque de porter ces souches PSDP etaient la creche (OR : 1,5, IC : 95 % [1,2 ; 1,9]) et avoir recu plus de deux cures d’ATB avant l’inclusion (OR : 2,6 (IC : 95 % [2,0 ; 3,4]). Pour H. influenzae, la proportion de souches productrices de beta-lactamase (BL+) etait de 17,1 % et celles resistantes aux beta-lactamines par modifications des proteines de liaisons a la penicilline (BLNAR+) representaient 7,7 % des cas. Trois facteurs augmentaient le risque de porter une souche BL+ ou BLNAR+ : l’âge superieur ou egal a12 mois (OR : 3,5, IC : 95 % [1,2 ; 10,3]), la prise de cephalosporine (OR : 2,5, IC : 95 % [1,0 ; 6,1]) et avoir recu deux cures ou plus d’ATB avant l’inclusion (OR : 3,1, IC : 95 % [1,2 ; 8,0]). Conclusion Les donnees de cette etude (diminution de la proportion de souches d ’H. influenzae BL+, augmentation des souches de pneumocoque intermediaires a la penicilline) doivent contribuer a modifier le choix des antibiotiques dans les OMA de l’enfant en reduisant, d’une part, le role des cephalosporines orales et, d’autre part, en remettant en premiere ligne l’amoxicilline associee ou non a l’acide clavulanique.

The choice of antibiotics (ATB) to treat acute otitis media (AOM) has to take into account the level of resistance of bacteria species implicated. The aim of this study was to evaluate in France, ATB resistance of pneumococci and H. influenzae isolated from the nasopharyngeal flora, in children with AOM, vaccinated with 7 valent pneumococcal conjugate vaccine (PCV7).From 2006 to 2010, 66 pediatricians performed nasopharyngeal specimens of children 6 to 24 months with AOM. Demographic characteristics, history, vaccination status and symptoms were reported on a case report form transmitted to ACTIV.Of the 3,501 children included (mean age 13.5 ± 5 months), over 98% were PCV7 vaccinated and 41.1% were cared in day care center. A total of 47.3% of children had received ATB within 3 months before inclusion (cephalosporins, 22.6% and amoxicillin clavulanate, 19.2%). Pneumococcus and H. influenzae carriage was respectively 57.9% and 48.2%. Pneumococcal strains with reduced susceptibility to penicillin represented 46.3% of cases (3.9% highly resistant strains and 42.4% intermediate resistant strains). Factors that increased the risk of carrying these strains were: day care center (OR: 1.5, 95% CI: [1.2, 1.9]) and two courses or more of ATB before inclusion (OR: 2.6 (95% CI: [2.0, 3.4]). For H. influenzae strains the proportion of ßlactamases+ producing strains was 17.1% and those with reduced susceptibility due to penicillin binding protein changes (BLNAR+ strains+) accounted for 7.7% of cases. Three factors increased the risk of carriage BLNAR+ ßlactamase+ producing strains: age equal or greater than 12 months (OR: 3.5, 95% CI: [1.2, 10.3]), cephalosporin use (OR: 2.5, 95% CI: [1.0, 6.1]) and two courses or more of ATB before inclusion (OR: 3.1, 95% CI: [1.2, 8.0]).The data in this study (reduction of ßlactamase producing H. influenzae strains and increase of intermediate penicillin pneumococcal strains) should help to change the choice of antibiotics for AOM in children in France, by reducing the role of oral cephalosporins and secondly, by giving frontline amoxicillin ± clavulanic acid.

A case of right unilateral pulmonary interstitial emphysema in a compromised premature infant was managed by right selective bronchial occlusion with a favorable outcome. Occlusion with a Rashkind catheter occurred on day 8 and was well-tolerated. The balloon was deflated 10 hours later and no recurrence was observed. Right occlusion is easier than left selective intubation and seems to be the best method for treatment of unilateral interstitial emphysema in infants in extremely poor conditions.