Abstract 189

Background: Hi remains the major pathogen causing hospitalisation for community acquired bacterial pneumonia in infants and children, despite specific Hi type b (Hib) vaccination, and despite efficient oral antibiotics available. Methods and Subjects: Retrospective analysis of microbiological data collected from bronchoalveolar lavage (BAL) during flexible fibre optic bronchoscopy performed in 354 patients suffering from severe LRT infection over a period of 24 months (Jan 1995-Dec 1996). Results: Cultures were positive for Hi in 110 (52 m; 58 f; 80% < 6 years) with 79% non typable Hi. Among the 21% typable 4% belonged to Hi serotype b. 25% were β-lactamase +. Before BAL 62 (56%) patients had received oral antibiotics (αβ) and 36 (33%) had not; for 12 (11%) retrospective information was not available (rina). αβ were wrongly selected for 3/62 (5%); for 3 patients rina. 56 patients (51%) did not improve despite theoretically correct αβ 11/62 did not improve despite a classical dose (for 51/62 i.e. 82% rina) and 4/62 despite a correct duration (for 4/62 the duration was too short; for 54/62 i.e. 87% rina). Conclusion: There remains a problem for LRT treated home, even when correct oral αβ are prescribed. Is this mainly due to bad tissue distribution, or to bad compliance? How to improve? This study also demonstrates that Hib will not protect about 95% of the LRT infections caused by Hi.