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Application of new sepsis definitions to evaluate outcome of pediatric patients with severe systemic infections
X Sáez-Llorens1, S Vargas, F Guerra
1Department of Pediatrics, Hospital del Niños, Panama City, Panama.
Insights
This study analyzed pediatric sepsis outcomes in a Latin American ICU, finding high mortality, especially with septic shock and organ dysfunction. Appropriate antimicrobial treatment significantly improved survival rates in critically ill children.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Epidemiology
Background:
- Limited data exists on pediatric sepsis outcomes using new terminology, particularly in developing nations.
- Systemic infections in children require updated classification and outcome analysis.
Purpose of the Study:
- To evaluate the outcomes of pediatric sepsis cases based on new terminology in a Latin American pediatric intensive care unit.
- To identify factors associated with mortality in pediatric sepsis.
Main Methods:
- A 12-year retrospective study of 815 infants and children with sepsis.
- Classification of patients into sepsis, severe sepsis, and septic shock groups.
- Analysis of mortality rates, organ dysfunction, causative organisms, and antimicrobial treatment appropriateness.
Main Results:
- Sepsis, severe sepsis, and septic shock occurred in 21%, 61%, and 18% of patients, respectively.
- Mortality was 39% overall, with higher rates in septic shock and multiorgan dysfunction.
- Inappropriate antimicrobial therapy was linked to significantly higher mortality (53% vs. 34%).
Conclusions:
- The new sepsis terminology aids in stratifying pediatric cases and comparing study data.
- Septic shock, organ dysfunction, and inappropriate antimicrobial treatment are critical factors influencing pediatric sepsis mortality.
- Further research into immunomodulating therapies for pediatric sepsis is warranted.
Abstract:
No published reports have stratified pediatric patients with systemic infections according to the new sepsis terminology guidelines. In addition little is known about the outcome of sepsis in developing countries. This large 12-year retrospective study evaluated the outcome of 815 infants and children with sepsis managed in a Latin American pediatric intensive care unit. Of these children 171 (21%) had sepsis, 497 (61%) had severe sepsis and 147 (18%) had septic shock. Multiorgan dysfunction was present in 120 (24%) and 77 (52%) patients with severe sepsis and septic shock, respectively. Infection was bacteriologically proved in 212 (26%) cases, with Staphylococcus aureus and Neisseria meningitidis being the most frequent responsible organisms. Three hundred nineteen (39%) patients died. Case-fatality rates were higher in patients with septic shock, multiorgan dysfunction, sepsis caused by Pseudomonas aeruginosa and meningococcemia than in those without these conditions. Although no difference in mortality was detected between culture-proved and culture-negative sepsis, more patients receiving an inappropriate antimicrobial agent died than those treated with an appropriate drug (53% vs. 34%, P = 0.012). We believe that with the use of the new terminology system a more reliable comparison of data from pediatric sepsis studies and of emerging immunomodulating therapeutic modalities can be achieved.