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Epidemiology of Pediatric Severe Sepsis in Main PICU Centers in Southwest China
Changxue Xiao1, Sa Wang1, Fang Fang1
1Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
Insights
Pediatric severe sepsis affects 2.3% of children in Southwest China, with high mortality rates. Early diagnosis and improved clinical management are crucial for better outcomes in pediatric intensive care units.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Epidemiology
Background:
- Severe sepsis in children presents a significant global health challenge.
- Understanding regional variations in pediatric severe sepsis is vital for targeted interventions.
- Southwest China has a high burden of pediatric critical illness, necessitating specific epidemiological data.
Purpose of the Study:
- To determine the prevalence of pediatric severe sepsis in major pediatric intensive care units (PICUs) in Southwest China.
- To analyze the management strategies and clinical outcomes of children diagnosed with severe sepsis or septic shock.
- To provide baseline data for improving care and research in this population.
Main Methods:
- A prospective, observational, multicenter study was conducted across eight PICUs in Southwest China.
- 10,598 pediatric patients admitted over one year were screened for severe sepsis or septic shock.
- 245 patients with complete data meeting sepsis criteria were included in the final analysis.
Main Results:
- The incidence of pediatric severe sepsis was 2.3%, with a hospital mortality rate of 18.8%.
- Respiratory dysfunction (76.7%) was the most common organ system affected, and the respiratory tract was the most frequent infection site (37.6%).
- Common treatments included antibiotics (99.0%), immunoglobulin (88.3%), and mechanical ventilation (78.4%); 86% had multiple organ dysfunction syndrome upon recognition.
Conclusions:
- This study provides the first comprehensive report on pediatric severe sepsis prevalence, management, and outcomes in Southwest China.
- The high mortality rate underscores the need for enhanced clinical management and early diagnostic strategies.
- Further large-scale clinical trials are recommended to improve treatment protocols and reduce mortality in pediatric severe sepsis.
Objectives:
To estimate the prevalence, management, and outcomes of pediatric severe sepsis in the main PICUs in Southwest China.
Design:
A prospective, observational, and multicenter study.
Setting:
Eight PICUs in Southwest China with 19 (13-24) beds and 1,322 (1,066-1,452) annual admissions each.
Patients:
A total of 10,598 patients (29 d to 18 yr old) were consecutively admitted between September 1, 2016, and August 31, 2017. All patients were screened and evaluated for severe sepsis or septic shock. Of them, 10,353 patients were excluded due to incomplete data or not meeting the consensus criteria for severe sepsis or septic shock; 245 patients were included with complete data.
Interventions:
None.
Measurements And Main Results:
Finally, 245 patients who were diagnosed with severe sepsis or septic shock were included in the study, with an incidence rate of 2.3%. Of them, 64.0% of the enrolled patients were male with 80.8% being less than 5 years old and 60.8% being from rural areas. The respiratory system was the most common organ system in which dysfunction was observed (76.7%) as well as the most frequently infected site (37.6%). The primary therapies were antibiotics (99.0%), immunoglobulin (88.3%), mechanical ventilation (78.4%), vasoactive infusions (59.6%), and corticosteroids (46.1%). Among the 188 patients who had respiratory dysfunction, 173(92%) required mechanical ventilation and 39 (20.7%) met the criteria for pediatric acute respiratory distress syndrome. Seven of the patients with pediatric acute respiratory distress syndrome died (7/39, 17.9%). The median durations for mechanical ventilation and vasoactive medications were 123.5 hours (35.25-226.00 hr) and 2 days (1-5 d), respectively. Eighty-six percent of patients had multiple organ dysfunction syndrome at the point at which severe sepsis was recognized, and 31% had underlying conditions. The hospital mortality rate was 18.8%.
Conclusions:
This report is the first to present the prevalence, treatment, and outcomes of pediatric severe sepsis in the main PICU centers in Southwest China. The mortality rate remains high; therefore, improved clinical management and implementation of large-scale clinical trials are necessary to improve early diagnoses and treatment.
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