Epidemiology of Sepsis Among Children and Neonates in Germany: Results From an Observational Study Based on Nationwide Diagnosis-Related Groups Data Between 2010 and 2016*

Abstract

OBJECTIVES: Worldwide, more than half of all sepsis cases occur in pediatric and adolescent patients, particularly in neonates. Previous population-based studies in these age groups often were limited to either neonatal or pediatric patients admitted to ICUs. We aimed to investigate the overall and age-specific incidence and case fatality of sepsis in children in Germany, a high-income country with a total population of 82 million. DESIGN: Retrospective observational study based on the German Diagnosis-related Groups statistics of the years 2010–2016. SETTING: All acute care hospitals in Germany except for prison and psychiatric hospitals. PATIENTS: Pediatric patients less than or equal to 19 years with International Classification of Diseases, 10th Revision-coded sepsis, neonates with International Classification of Diseases, 10th Revision-coded neonatal sepsis. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We analyzed pediatric sepsis incidence in patients aged birth to less than or equal to 19 years old, case fatality, and underlying comorbidities, and neonatal sepsis incidence and case fatality within the neonatal period. We identified 14,635 pediatric sepsis cases among 15.4 million pediatric hospitalizations between 2010 and 2016 (= 0.1% of pediatric hospitalizations). The incidence of pediatric sepsis was 14 cases per 100,000 children between 0 and 19 years. Case fatality was 16.6% and decreased from 17.8% (2010) to 15.0% (2016). A total of 11.5% of hospital deaths in the age group 0–19 years were associated with pediatric sepsis. Sepsis incidence and case fatality were highest in children less than 1 year old and declined in older children and adolescents. Admissions with pediatric sepsis were more common in children with preexisting comorbidities compared with those without (0.52% vs 0.03% of pediatric admissions). In neonates, the incidence of neonatal sepsis was 1,006 cases per 100,000 live births. Case fatality was 3.9%. While 17.7% of very low birth weight infants had neonatal sepsis, only 2.1% of low birth weight and 0.6% of normal birth weight neonates were affected, respectively. CONCLUSIONS: Sepsis is also in Germany a common and frequently fatal condition in pediatric patients, particularly among neonates and children with comorbidities.

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“…Neonatal and perinatal sepsis are excluded from this study as there are differences in the definition, epidemiology and pathogenesis of sepsis in these patients. 19,21 Studies that do not provide an explicit definition for severe sepsis or septic shock were excluded. The following study designs were included in our review: randomized control trials (RCTs: including post hoc analysis provided there is no duplicated data), prospective and retrospective studies.…”

A pediatric perspective on World Sepsis Day in 2021: leveraging lessons from the pandemic to reduce the global pediatric sepsis burden?

“…In recent years, a number of large contemporary population-based observational cohorts reporting on ongoing high incidence of pediatric sepsis have been published in several high income countries such as Australia and New Zealand (53), the United States ( 15), Switzerland (1), and Germany (6). While sepsis mortality in these settings overall is slowly decreasing, the mortality of children requiring ICU admission due to septic shock remains high and varies widely depending on resources (35,59) (63).…”

“…In Australia, the National Commission on Safety and Quality in Healthcare launched a sepsis program aiming to improve early recognition, treatment, outcomes, and postdischarge support for patients with sepsis (https://www.safetyandquality.gov.au/our-work/national-sepsisprogram). Similar initiatives arer lacking in many other wealthy countries such as Germany or Switzerland, despite studies showing a substantial burden (1,6).…”

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