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Epidemiology of sepsis in pediatric intensive care units: first Colombian multicenter study
Juan C Jaramillo-Bustamante1, Alejandro Marín-Agudelo, Mauricio Fernández-Laverde
1From the CES University (JCJ-B, AM-A, MF-L), Pediatric Intensive Care Program, Medellín, Colombia. juancajara@sepsisencolombia.com
Insights
Sepsis is a significant concern in Colombian pediatric intensive care units, affecting many young children. Key risk factors for mortality include young age, shock, organ dysfunction, and Gram-negative bacteria infections.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Epidemiology
Background:
- Sepsis is a leading cause of death with substantial economic and social costs.
- Limited epidemiologic data exists for pediatric sepsis, particularly in Colombia.
- The Surviving Sepsis Campaign highlighted the need for increased awareness and research.
Purpose of the Study:
- To describe the sociodemographic and clinical characteristics of pediatric sepsis patients in Colombia.
- To identify risk factors associated with sepsis and its outcomes in a pediatric intensive care setting.
- To provide crucial epidemiologic data on pediatric sepsis in a developing country context.
Main Methods:
- A prospective study was conducted across 19 pediatric intensive care units in Colombia.
- Data was collected via a dedicated website (sepsisencolombia.com) over a one-year period (March 2009-February 2010).
- Sociodemographic and clinical data of 1,051 pediatric sepsis patients were analyzed.
Main Results:
- 1,051 pediatric patients were included; 55% were male, 56% were under 2 years old, and 76% from low socioeconomic strata.
- Sepsis, severe sepsis, and septic shock affected 27%, 25%, and 48% of patients, respectively. Multiple organ dysfunction syndrome was present in 43%.
- Respiratory infections were the most common source (54%). Gram-negative bacteria were frequent etiological agents with high mortality. Overall mortality was 18%, with younger age, shock, organ dysfunction, and Gram-negative bacteria as significant risk factors.
Conclusions:
- Sepsis is a prevalent condition in Colombian pediatric intensive care units.
- Specific risk factors for sepsis acquisition and mortality have been identified.
- The considerable mortality rate underscores the significant public health challenge sepsis poses in developing societies.
Objectives:
In 2002, the Surviving Sepsis Campaign pointed out the need to recognize sepsis as an important cause of death and high economic and social costs. There are few epidemiologic studies of this disease in pediatrics and none in Colombia. The objective of this study was to describe the sociodemographic and clinical characteristics of patients with sepsis who were admitted at participating pediatric intensive care units.
Design:
Prospective study.
Setting And Patients:
A Web site, http://www.sepsisencolombia.com, was created, in which 19 pediatric intensive care units from the ten principal cities in the country reported epidemiologic data about patients with sepsis between March 1, 2009, and February 28, 2010.
Interventions:
None.
Measurements And Main Results:
There were 1,051 patients. Of these, 55% were male. Fifty-six percent came from urban areas. Fifty-six percent were <2 yrs of age. Seventy-six percent belonged to a low socioeconomic strata and 44% received government-subsidized health insurance. Forty-eight percent of patients had septic shock, 25% severe sepsis, and 27% sepsis. Forty-three percent were diagnosed with multiple organ dysfunction syndrome. In 54%, the infection was of respiratory origin followed by the abdomen as the site of origin in 18% of the patients. In almost 50%, the etiological agent was detected with Gram-negative bacteria being the most frequent and of highest mortality. Fifty percent had some type of relevant pathologic antecedent. Eleven percent had an invasive device on admission. Sixty-eight percent of the patients required mechanical ventilation. Mortality rate was 18%. The most important risk factors for mortality were age under 2 yrs, presence of shock or multiple organ dysfunction syndrome, and presence of Gram-negative bacteria.
Conclusions:
Sepsis is common in Colombian pediatric intensive care units. Clear risk factors for getting sick and dying from this disease were identified. Mortality resulting from this disease is considerable for a developing society like ours.
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