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Life-threatening infections in children in Europe (the EUCLIDS Project): a prospective cohort study
Federico Martinón-Torres1, Antonio Salas2, Irene Rivero-Calle1
1Pediatrics Department, Translational Pediatrics and Infectious Diseases Section, Santiago de Compostela, Spain; Genetics- Vaccines- Infectious Diseases and Pediatrics research group GENVIP, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain.
Insights
Childhood sepsis and severe infections in Europe have low mortality, primarily affecting children under 5. Vaccine-preventable bacteria like meningococcus and pneumococcus are key culprits, yet pathogens remain unidentified in half of cases.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Public Health
Background:
- Sepsis and severe focal infections pose a significant health challenge for hospitalized children.
- Understanding the disease burden and outcomes of life-threatening bacterial infections in European children is crucial.
Purpose of the Study:
- To investigate the disease burden and outcomes of life-threatening bacterial infections in children across Europe.
- To identify common pathogens and risk factors associated with severe pediatric infections.
Main Methods:
- A prospective, multicentre cohort study (EUCLIDS) was conducted in 6 European countries.
- Recruited 2844 children (1 month to 18 years) with sepsis or severe focal infections between 2012 and 2015.
- Collected demographic, clinical, and microbiological data via a web-based platform and local diagnostic procedures.
Main Results:
- Sepsis occurred in 43.2% and severe focal infections in 56.8% of patients; the median age was 39.1 months.
- Pneumonia, CNS infections, and skin/soft tissue infections were the most common syndromes.
- Neisseria meningitidis, Staphylococcus aureus, and Streptococcus pneumoniae were the most frequent identified pathogens; overall mortality was 2.2%.
Conclusions:
- Mortality for pediatric sepsis and severe focal infections in Europe is low, predominantly impacting children under 5.
- Vaccine-preventable infections (meningococcal, pneumococcal) contribute significantly to the disease burden.
- The causative organism remains unidentified in approximately 50% of cases, highlighting diagnostic challenges.
Background:
Sepsis and severe focal infections represent a substantial disease burden in children admitted to hospital. We aimed to understand the burden of disease and outcomes in children with life-threatening bacterial infections in Europe.
Methods:
The European Union Childhood Life-threatening Infectious Disease Study (EUCLIDS) was a prospective, multicentre, cohort study done in six countries in Europe. Patients aged 1 month to 18 years with sepsis (or suspected sepsis) or severe focal infections, admitted to 98 participating hospitals in the UK, Austria, Germany, Lithuania, Spain, and the Netherlands were prospectively recruited between July 1, 2012, and Dec 31, 2015. To assess disease burden and outcomes, we collected demographic and clinical data using a secured web-based platform and obtained microbiological data using locally available clinical diagnostic procedures.
Findings:
2844 patients were recruited and included in the analysis. 1512 (53·2%) of 2841 patients were male and median age was 39·1 months (IQR 12·4-93·9). 1229 (43·2%) patients had sepsis and 1615 (56·8%) had severe focal infections. Patients diagnosed with sepsis had a median age of 27·6 months (IQR 9·0-80·2), whereas those diagnosed with severe focal infections had a median age of 46·5 months (15·8-100·4; p<0·0001). Of 2844 patients in the entire cohort, the main clinical syndromes were pneumonia (511 [18·0%] patients), CNS infection (469 [16·5%]), and skin and soft tissue infection (247 [8·7%]). The causal microorganism was identified in 1359 (47·8%) children, with the most prevalent ones being Neisseria meningitidis (in 259 [9·1%] patients), followed by Staphylococcus aureus (in 222 [7·8%]), Streptococcus pneumoniae (in 219 [7·7%]), and group A streptococcus (in 162 [5·7%]). 1070 (37·6%) patients required admission to a paediatric intensive care unit. Of 2469 patients with outcome data, 57 (2·2%) deaths occurred: seven were in patients with severe focal infections and 50 in those with sepsis.
Interpretation:
Mortality in children admitted to hospital for sepsis or severe focal infections is low in Europe. The disease burden is mainly in children younger than 5 years and is largely due to vaccine-preventable meningococcal and pneumococcal infections. Despite the availability and application of clinical procedures for microbiological diagnosis, the causative organism remained unidentified in approximately 50% of patients.
Funding:
European Union's Seventh Framework programme.
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