Comparison between hospital- and community-acquired septic shock in children: a single-center retrospective cohort study

Abstract

Background We explored the differences in baseline characteristics, pathogens, complications, outcomes, and risk factors between children with hospital-acquired septic shock (HASS) and community-acquired septic shock (CASS) in the pediatric intensive care unit (PICU). Methods This retrospective study enrolled children with septic shock at the PICU of Beijing Children’s Hospital from January 1, 2016, to December 31, 2019. The patients were followed up until 28 days after shock or death and were divided into the HASS and CASS group. Logistic regression analysis was used to identify risk factors for mortality. Results A total of 298 children were enrolled. Among them, 65.9% (n = 91) of HASS patients had hematologic/oncologic diseases, mainly with Gram-negative bacterial bloodstream infections (47.3%). Additionally, 67.7% (n = 207) of CASS patients had no obvious underlying disease, and most experienced Gram-positive bacterial infections (30.9%) of the respiratory or central nervous system. The 28-day mortality was 62.6% and 32.7% in the HASS and CASS groups, respectively (P < 0.001). Platelet [odds ratio (OR) = 0.996, 95% confidence interval (CI) = 0.992–1.000, P = 0.028], positive pathogen detection (OR = 3.557, 95% CI = 1.307–9.684, P = 0.013), and multiple organ dysfunction syndrome (OR = 10.953, 95% CI = 1.974–60.775, P = 0.006) were risk factors for 28-day mortality in HASS patients. Lactate (OR = 1.104, 95% CI = 1.022–1.192, P = 0.012) and mechanical ventilation (OR = 8.114, 95% CI = 1.806–36.465, P = 0.006) were risk factors for 28-day mortality in patients with CASS. Conclusions The underlying diseases, pathogens, complications, prognosis, and mortality rates varied widely between the HASS and CASS groups. The predictors of 28-day mortality were different between HASS and CASS pediatric patients with septic shock.

Epidemiology and Clinical Characteristics of Pediatric Sepsis in PICUs in Southwest China: A Prospective Multicenter Study*

“…In our results, the proportion of boys with sepsis was higher than that of girls, which was consistent with the results of a single-center retrospective study in China (15). However, the results of our univariate logistic regression analysis suggested that there was no significant correlation between sex and sepsis mortality, similar to the findings of de Souza et al ( 16) and Boeddha et al (17).…”

Comparison of patients with community-acquired and hospital-acquired sepsis or septic shock: a systematic review and meta-analysis

“…Study quality was de ned as poor (0-3), fair (4-6) or good (7)(8)(9). The quality of the included cohort studies is presented in Table 1 [11][12][13][16][17][18][19][20][21][22][23][24][25]. Westphal 2019 [20] Padro 2019 [13] Rhee 2019 [21] Baghdadi 2020 [22] Baghdadi 2020 [23] Di Giuseppe 2020 [24] and standard deviation with an calculator according to the sample size [27], and then performed meta-analysis.…”