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Clinical Characteristics, Microbiological Profile, and Mortality Predictors in Pediatric Community-Acquired Sepsis: A
Pınar Önal1, Fatih Aygün2, Berfin Ayla Hastürk Şen3
1Department of Pediatric Infectious Diseases, İstanbul University-Cerrahpaşa Cerrahpaşa Faculty of Medicine, İstanbul, Türkiye.
Insights
Pediatric community-acquired sepsis, primarily caused by Staphylococcus aureus, has a 6.5% mortality rate. Acute kidney injury and mechanical ventilation are key risk factors for death in children.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Microbiology
Background:
- Sepsis is a leading cause of death in pediatric intensive care units (PICUs).
- Community-acquired sepsis in children presents unique challenges due to immature immunity and antimicrobial resistance.
- Understanding risk factors and pathogens is crucial for improving outcomes.
Purpose of the Study:
- To investigate the clinical features, microbial causes, and treatment of pediatric community-acquired sepsis.
- To identify risk factors associated with mortality in these critically ill children.
Main Methods:
- Retrospective single-center study of 107 children with community-acquired sepsis admitted to the PICU.
- Data collected included demographics, clinical status, laboratory results, and microbiology.
- Analysis based on culture results and survival.
Main Results:
- Overall mortality was 6.5%.
- Staphylococcus aureus was the most common pathogen (46.7%), followed by Pseudomonas and Acinetobacter species.
- Mortality was linked to acute kidney injury (AKI), mechanical ventilation, and longer ventilation duration.
Conclusions:
- Staphylococcus aureus is the primary pathogen in pediatric community-acquired sepsis.
- AKI and mechanical ventilation are critical complications associated with mortality.
- Early gram-negative infections in infants may indicate underlying immunodeficiency.
Objective:
Sepsis remains a major cause of morbidity and mortality in pediatric intensive care units (PICUs). Community-acquired sepsis presents distinct challenges in children due to immature immunity, variable clinical features, and emerging antimicrobial resistance. This study aimed to evaluate the clinical characteristics, microbiological profile, treatment, and mortalityrelated possible risk factors for mortality in pediatric community-acquired sepsis.
Materials And Methods:
This retrospective single-center study included 107 previously healthy children diagnosed with community-acquired sepsis and admitted to the PICU between February 2020 and June 2023. Demographic, clinical, laboratory, and microbiological data were retrieved from electronic medical records. Patients were analyzed based on culture positivity and survival status.
Results:
Among 1853 PICU admissions, 107 met the inclusion criteria. The median age was 2.5 years, and the overall mortality rate was 6.5%. Blood culture positivity was 14%, with Staphylococcus aureus as the most common pathogen (46.7%), followed by Pseudomonas and Acinetobacter species (13.3% each). Pulmonary involvement was the most common infection site (28%). Mortality was significantly associated with acute kidney injury (AKI), invasive mechanical ventilation, and longer ventilation duration. Culture positivity correlated with longer hospital and noninvasive ventilation duration.
Conclusion:
Staphylococcus aureus was the leading cause of pediatric community-acquired sepsis. Critical complications such as AKI, mechanical ventilation, and a higher number of red blood cell transfusions were linked to mortality. All children with proven gram-negative sepsis were under 1.5 years, and 2 were later diagnosed with primary immunodeficiency, suggesting that early gram-negative infections in infants may reflect an underlying immune defect, as immunodeficiencies predispose to sepsis caused by unusual or atypical pathogens. Timely diagnosis and careful management are vital for better outcomes in vulnerable patients.
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