A multi-sectoral investigation of a neonatal unit outbreak of Klebsiella pneumoniae bacteraemia at a regional hospital in South Africa, 2018

Abstract

Background:The Vasoactive Inotropic Score (VIS) is an objective clinical tool that was used to quantify the need for cardiovascular support and used as a predictor of morbidity and mortality in children with septic shock.Methods and materials: This is a prospective cohort study of all septic shock patients aged 1 m to 18 y who were admitted at the PICU. Vasoactive Inotropic Score was calculated at initial, 6, 12, 24, and 48 h post PICU admission as described by Gaies, et. al. Demographic and clinical data were collected. Primary outcomes were ventilator days and ICU length of stay while secondary outcomes were death during hospitalization, cardiac arrest, and need for intubation. STATA 13.1 was used for data analysis. Appropriate descriptive and analytical statistical tests were applied for this data and a P-value <0.05 was considered significant.Results: Eighty-four patients met the inclusion criteria and were enrolled in the study. Sixty-two (73.81%) patients were intubated, 34 (40.48%) went into cardiac arrest and 33 (39.29%) died during hospitalization. Fourteen (22.22%) patients were ventilated for 6 days or more and 20 (23.81%) stayed in the PICU for 12 d or more. This study showed a strong association between VIS at initial, 6, 12, 24, 48 h and maximum VIS with the risk of intubation (P-value of 0.047, 0.007, 0.012, 0.026, 0.012, and 0.009), cardiac arrest (P-value of 0.001-initial; <0.001-6 to 48 h and maximum VIS) and death during hospitalization (P-value of 0.002-initial; <0.001-6 to 48 h and maximum VIS). Results showed that initial upto maximum VIS within 48 h may capture a component of illness in pediatric septic shock and served as a surrogate outcome that highlights cardiovascular instability.Conclusion: This study showed that VIS is independently associated with poor outcomes such as risk for intubation, cardiac arrest, and death during hospitalization. VIS is easily measured and, if validated in pediatric sepsis, has the potential to standardize the quantification of hemodynamic support, identify, and stratify high-risk patient populations, and be used as a surrogate outcome measure.