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Master Thesis

Développement et validation interne d’un outil de diagnostic des infections bactériennes invasives chez le nourrisson fébrile âgé de moins de trois mois

Abstract : Introduction: the management of infants younger than 3 months of age is heterogeneous. The objective was to develop a predictive model of the risk of invasive bacterial infections (IBI) in febrile infants younger than 3 months of age, consulting to pediatric emergency department. Material and methods: pronour is a prospective observational study, a multicentric cohort, in 15 french pediatric emergency centers, conducted between October 2008 and March 2011. The selected event is the IBI, and the reference population, febrile infants without IBI, by excluding those diagnosed with a severe bacterial infection (SBI). We built our diagnostic tool following two techniques: the recursive partition and multivariate logistic regression, with an approach based on the gray zone, to classify infants into three groups. We evaluated the final model performance thanks to its discriminatory power and we looked for a sensitivity of 100%. Internal validation was assessed by bootstrap resampling method. Results: 2024 infants were included in the Pronour study, we worked on 1824 infants, not having any SBI. We have retained a score by multivariate logistic regression, recursive partition did not show usable results. The variables used for the final model are: the temperature measured at emergency department and the dosages of procalcitonin, the C-Reactive protein and neutrophils account. The area under the curve of the model is 0.959 (0, 933-0, 992), the sensitivity is 100% (93, 6-100) and the negative predictive value is 100% (99, 9-100). This model allows to classify infants into three groups: infants without IBI (1027 or 63.1%), infants requiring supervision or additional tests (566 or 34.7%) and infants with a probable diagnosis of IBI (35 or 2.2%). Conclusion: we could create a powerful tool of diagnosis of the IBI in febrile infants aged less of 3 months, allowing the identification of infants potentially reached an IBI.
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Master Thesis
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Sebastien Walser. Développement et validation interne d’un outil de diagnostic des infections bactériennes invasives chez le nourrisson fébrile âgé de moins de trois mois. Médecine humaine et pathologie. 2018. ⟨dumas-02304276⟩

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