Objectives: To describe the incidence and mortality of invasive infections in Indigenous children admitted to paediatric and general intensive care units (ICUs) in Australia. Design: Retrospective multi‐centre cohort study of Australian and New Zealand Paediatric Intensive Care Registry data. Participants: All children under 16 years of age admitted to an ICU in Australia, 1 January 2002 – 31 December 2013. Indigenous children were defined as those identified as Aboriginal and/or Torres Strait Islander in a mandatory admissions dataset. Main outcomes: Population‐based ICU mortality and admission rates. Results: Invasive infections accounted for 23.0% of non‐elective ICU admissions of Indigenous children (726 of 3150), resulting in an admission rate of 47.6 per 100 000 children per year. Staphylococcus aureus was the leading pathogen identified in children with sepsis/septic shock (incidence, 4.42 per 100 000 Indigenous children per year; 0.57 per 100 000 non‐Indigenous children per year; incidence rate ratio 7.7; 95% CI, 5.8–10.1; P < 0.001). While crude and risk‐adjusted ICU mortality related to invasive infections was not significantly different for Indigenous and non‐Indigenous children (odds ratio, 0.75; 95% CI, 0.53–1.07; P = 0.12), the estimated population‐based age‐standardised mortality rate for invasive infections was significantly higher for Indigenous children (2.67 per 100 000 per year v 1.04 per 100 000 per year; crude incidence rate ratio, 2.65; 95% CI, 1.88–3.64; P < 0.001). Conclusions: The ICU admission rate for severe infections was several times higher for Indigenous than for non‐Indigenous children, particularly for S. aureus infections. While ICU case fatality rates were similar, the population‐based mortality was more than twice as high for Indigenous children. Our study highlights an important area of inequality in health care for Indigenous children in a high income country that needs urgent attention.

Critically ill patients receiving renal replacement therapy (RRT) for acute kidney injury (AKI) have high reported intensive care unit (ICU) mortality. Blood culture (BC) collection practices in this population have to date been poorly characterised, specifically in regards to the influence of RRT on the clinical triggers for such an investigation. Utilising our electronic clinical information system, we conducted a retrospective observational study of patients admitted to a 30-bed tertiary level ICU and requiring RRT over a four-year period. Patients with a history of chronic kidney disease, prior RRT or ICU length-of-stay (LOS) <48 hours were excluded. Two hundred and thirty-one patients treated with RRT for AKI were identified. The observed median [interquartile range] BC collection rate in those having them drawn was 18 [11-32] per 100 patient days, although 42% of the cohort had no BC drawn during their ICU stay. Application of RRT in the 24 hours prior to initial BC collection was associated with lower body temperatures, higher white cell counts and greater use of vasopressor therapy. Bloodstream infection (identified from the first BC) was associated with greater ICU and in-hospital mortality. We also observed a predominance of candidaemia in this cohort, despite the absence of neutropenia. This study provides unique data describing BC collection rates in a cohort of critically ill patients receiving RRT for AKI and at high risk of dying. Further study of temperature alteration, detection of bloodstream infection and outcome in patients receiving RRT is now warranted.