Évaluation des pratiques professionnelles : pertinence de la prescription de PCR Bordetella chez l'enfant

Abstract : Objectives: To discuss the relevance of the prescription of Bordetella real-time polymerase chain reaction (RT-PCR) on a nasopharyngeal sample in less than 15 years-old children. Material and methods: A retrospective study was conducted among all the patients less than 15-years-old suspected of whooping cough who had a nasopharyngeal sample for Bordetella PCR, from January 1st, 2015 to December 31st, 2017, in three hospitals of Marseille. Clinical data was also collected over year 2017 for a focused analysis. Results: From year 2015 to 2017, the included PCR demands involved 3197 analyses for 2760 patients, with 32% of samples regarding less than 1-year-old infant. Global positivity rate was of 1.00 % i.e. 32 PCR-confirmed pertussis. Among these, 29 were performed before 1 year of age, showing a significant link between this age range and the PCR positivity (p <0.001). On year 2017, 981 PCR demands were included (828 patients), with a total of 19 PCR-confirmed pertussis. 668 PCR prescriptions regarded less than one-year infants (68.1%). PCR demands were significantly more frequent for this age range (p < 0.001). 18 PCR-confirmed pertussis (91.7%) regarded less than one-year-old infants, with a statistically significant association between age under one-year-old and PCR positivity (p = 0.01). At least 383 prescriptions (39%) could have been avoided, given incorrect indications. Conclusion: Clinicians should narrow down Bordetella PCR prescriptions to less than one-year-old infants with respiratory symptoms such as cough, apnea, or clinically typical form of whooping cough, especially in case of incomplete immunization.
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Nathaniel Ghez. Évaluation des pratiques professionnelles : pertinence de la prescription de PCR Bordetella chez l'enfant. Sciences du Vivant [q-bio]. 2018. ⟨dumas-02086351⟩

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