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Infectious Etiologies and Patient Outcomes in Pediatric Septic Shock
Stefanie G Ames1, Jennifer K Workman2, Jared A Olson3
1Department of Pediatrics.
Insights
Early antibiotics for pediatric septic shock in children do not increase the risk of organ dysfunction or death, even in sicker patients. This finding supports timely treatment for critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Infectious Diseases
- Emergency Medicine
Background:
- Septic shock is a significant cause of mortality and morbidity in pediatric patients.
- Early recognition and prompt treatment are crucial for optimal outcomes in pediatric septic shock.
Purpose of the Study:
- To investigate the association between the timing of antibiotic administration and patient outcomes in pediatric septic shock.
- To determine if early empiric or appropriate antibiotic therapy impacts the development of new or progressive multiple organ dysfunction syndrome (NP-MODS) or mortality.
Main Methods:
- Retrospective cohort study of children (<19 years) treated for septic shock in an emergency department (ED) from 2008-2012.
- Exposures included receipt of empiric antibiotics within ≤1 hour and receipt of appropriate antibiotics within ≤1 hour.
- Primary outcome was NP-MODS; secondary outcome was mortality.
Main Results:
- 48% of patients received empiric antibiotics within ≤1 hour. These patients were sicker (higher PIM2 scores) but had similar rates of NP-MODS and mortality compared to those treated later.
- 33% received early, appropriate antibiotics for suspected bacterial infection. Despite higher PIM2 scores, these patients also had similar NP-MODS and mortality rates.
- Early antibiotic administration in pediatric septic shock did not correlate with increased risk of NP-MODS or death.
Conclusions:
- Critically ill children with septic shock receiving antibiotics within ≤1 hour were more severely ill but did not experience increased risk of NP-MODS or death.
- These findings suggest that early antibiotic administration is safe and does not worsen outcomes in pediatric septic shock.
- The study supports the importance of timely antibiotic therapy in the management of pediatric septic shock.
Background:
Septic shock remains an important cause of death and disability in children. Optimal care requires early recognition and treatment.
Methods:
We evaluated a retrospective cohort of children (age <19) treated in our emergency department (ED) for septic shock during 2008-2012 to investigate the association between timing of antibiotic therapy and outcomes. The exposures were (1) receipt of empiric antibiotics in ≤1 hour and (2) receipt of appropriate antibiotics in ≤1 hour. The primary outcome was development of new or progressive multiple system organ dysfunction syndrome (NP-MODS). The secondary outcome was mortality.
Results:
Among 321 patients admitted to intensive care, 48% (n = 153) received empiric antibiotics in ≤1 hour. These patients were more ill at presentation with significantly greater median pediatric index of mortality 2 (PIM2) scores and were more likely to receive recommended resuscitation in the ED (61% vs 14%); however, rates of NP-MODS (9% vs 12%) and hospital mortality (7% vs 4%) were similar to those treated later. Early, appropriate antibiotics were administered to 33% (n = 67) of patients with identified or suspected bacterial infection. These patients had significantly greater PIM2 scores but similar rates of NP-MODS (15% vs 15%) and hospital mortality (10% vs 6%) to those treated later.
Conclusions:
Critically ill children with septic shock treated in a children's hospital ED who received antibiotics in ≤1 hour were significantly more severely ill than those treated later, but they did not have increased risk of NP-MODS or death.
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