Epidemiology of sepsis in pediatric intensive care units

Jaramillo-Bustamante, Juan Camilo; Marín-Agudelo, Alejandro; Fernández-Laverde, Mauricio; Silva, José Bareño

doi:10.1097/pcc.0b013e31823c980f

Cited by 100 publications

(100 citation statements)

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“…The mortality in the present study also reflects the high rate of multiorgan dysfunction. In previous studies, investigators have reported 19-57% mortality for pediatric patients with sepsisassociated MODS (2,3,48). Thus, the mortality reported in our present study is indicative of the critically ill subset of children with sepsis-associated MODS who should be targeted for enrollment into interventional trials.…”

Section: Discussionmentioning

confidence: 65%

“…However, these studies used International Classification of Diseases, Ninth Revision (ICD-9), codes, which have been shown to capture a lower severity of illness and thereby underestimate mortality (5,7). In a recent database study using expanded ICD-9 coding, researchers reported a PICU mortality of 26.4% (6), and authors of prospective studies have reported short-term mortality rates up to 24% (2,5,19,46,47). The mortality in the present study also reflects the high rate of multiorgan dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…Recent reports of a rising prevalence of pediatric sepsis (1,6,7) may reflect an expanding vulnerable population with chronic comorbidities (8,9), increasing rates of multidrug-resistant organisms and opportunistic infections (10,11), and a surge in sepsis surveillance (12,13). However, shifting patterns of diagnostic coding may confound current epidemiological estimates that are based largely on retrospectively identified cases in administrative databases (5,14), and prior studies using prospective case identification have been limited to few sites within single countries, thus precluding broad generalizations (2,5,15). To date, no pediatric studies have examined the epidemiology and global burden of severe sepsis across multiple countries using a prospective methodology.…”

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confidence: 99%

“…Severe sepsis is a life-threatening condition commonly treated in pediatric intensive care units (PICUs) worldwide (1)(2)(3)(4)(5). It is estimated that over one-third of children who die in tertiary care PICUs within the United States have severe sepsis (6).…”

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confidence: 99%

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Global Epidemiology of Pediatric Severe Sepsis: The Sepsis Prevalence, Outcomes, and Therapies Study

Weiss

Fitzgerald

Pappachan

et al. 2015

Am J Respir Crit Care Med

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848

625

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Rationale: Limited data exist about the international burden of severe sepsis in critically ill children.Objectives: To characterize the global prevalence, therapies, and outcomes of severe sepsis in pediatric intensive care units to better inform interventional trials.Methods: A point prevalence study was conducted on 5 days throughout 2013-2014 at 128 sites in 26 countries. Patients younger than 18 years of age with severe sepsis as defined by consensus criteria were included. Outcomes were severe sepsis point prevalence, therapies used, new or progressive multiorgan dysfunction, ventilator-and vasoactive-free days at Day 28, functional status, and mortality.Measurements and Main Results: Of 6,925 patients screened, 569 had severe sepsis (prevalence, 8.2%; 95% confidence interval, 7.6-8.9%). The patients' median age was 3.0 (interquartile range [IQR], 0.7-11.0) years. The most frequent sites of infection were respiratory (40%) and bloodstream (19%). Common therapies included mechanical ventilation (74% of patients), vasoactive infusions (55%), and corticosteroids (45%). Hospital mortality was 25% and did not differ by age or between developed and resourcelimited countries. Median ventilator-free days were 16 (IQR, 0-25), and vasoactive-free days were 23 (IQR,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). Sixty-seven percent of patients had multiorgan dysfunction at sepsis recognition, with 30% subsequently developing new or progressive multiorgan dysfunction. Among survivors, 17% developed at least moderate disability. Sample sizes needed to detect a 5-10% absolute risk reduction in outcomes within interventional trials are estimated between 165 and 1,437 patients per group.Conclusions: Pediatric severe sepsis remains a burdensome public health problem, with prevalence, morbidity, and mortality rates similar to those reported in critically ill adult populations. International clinical trials targeting children with severe sepsis are warranted.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Global Epidemiology of Pediatric Severe Sepsis: The Sepsis Prevalence, Outcomes, and Therapies Study

Weiss

Fitzgerald

Pappachan

et al. 2015

Am J Respir Crit Care Med

Self Cite

848

625

View full text Add to dashboard Cite

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“…Local epidemiologic studies about pediatric sepsis have been undertaken, most of them in developed countries. However, the important differences between children in developing countries and those in developing ones are clear [8].…”

Section: Introductionmentioning

confidence: 99%

Clinical and epidemiological characteristics of children admitted with fever in emergency department with or without sepsis

Sant'ana

Amoedo

Nascimento‐Carvalho

2017

J Infect Dev Ctries

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Introduction: Sepsis is a major cause of childhood death worldwide. In developing countries, epidemiological data about sepsis is scarce. This study describes and compares the frequency of etiological agents and initial sites of infection in children with or without sepsis, identifying risk factors and assessing outcomes. Methodology: Clinical and demographic data from patients < 13 years of age with reported fever in a pediatric emergency department were collected and registered in forms. Patients were classified as with or without sepsis according to Goldstein et al.'s criteria [6]. Results: Of 254 patients, 120 (47%) did and 134 (53%) did not meet the sepsis definition. Overall, the median age (IQR) was 1.7 (0.8-3.9) years, and 153 (60%) were boys. Patients with sepsis were older (2.8 [1.1-5.3] versus 1.3 [0.6-2.9] years; p < 0.001) and had sickle-cell disease more frequently (7.6% versus 0.8%; p = 0.007). By multiple logistic regression, age and sickle-cell disease were independently associated with sepsis. The most frequent initial infections were pneumonia (43.7%), diarrhea (17.3%) and cellulitis/adenitis (13.0%). The frequency of these did not differ when patients with or without sepsis were compared. Etiology was established in 57 (22.4%) patients, 32 (26.7%), and 25 (18.7%) with or without sepsis, respectively. Four (3.3%) patients died in the sepsis subgroup, whereas none died in the other subgroup. Conclusions: Children who met the 2005 international consensus definition of sepsis showed differences in age and comorbidities (sickle-cell disease) upon admission and were more likely to die.

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Global Case-Fatality Rates in Pediatric Severe Sepsis and Septic Shock

et al. 2019

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IMPORTANCE The global patterns and distribution of case-fatality rates (CFRs) in pediatric severe sepsis and septic shock remain poorly described. OBJECTIVE We performed a systematic review and meta-analysis of studies of children with severe sepsis and septic shock to elucidate the patterns of CFRs in developing and developed countries over time. We also described factors associated with CFRs. DATA SOURCES We searched PubMed, Web of Science, Excerpta Medica database, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Cochrane Central systematically for randomized clinical trials and prospective observational studies from earliest publication until January 2017, using the keywords "pediatric," "sepsis," "septic shock," and "mortality." STUDY SELECTION Studies involving children with severe sepsis and septic shock that reported CFRs were included. Retrospective studies and studies including only neonates were excluded. DATA EXTRACTION AND SYNTHESIS We conducted our systematic review and meta-analysis in close accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled case-fatality estimates were obtained using random-effects meta-analysis. The associations of study period, study design, sepsis severity, age, and continents in which studies occurred were assessed with meta-regression. MAIN OUTCOMES AND MEASURES Meta-analyses to provide pooled estimates of CFR of pediatric severe sepsis and septic shock over time. RESULTS Ninety-four studies that included 7561 patients were included. Pooled CFRs were higher in developing countries (31.7% [95% CI, 27.3%-36.4%]) than in developed countries (19.3% [95% CI, 16.4%-22.7%]; P < .001). Meta-analysis of CFRs also showed significant heterogeneity across studies. Continents that include mainly developing countries reported higher CFRs (adjusted odds ratios: Africa, 7.89 [95% CI, 6.02-10.32]; P < .001; Asia, 3.81 [95% CI, 3.60-4.03]; P < .001; South America, 2.91 [95% CI, 2.71-3.12]; P < .001) than North America. Septic shock was associated with higher CFRs than severe sepsis (adjusted odds ratios, 1.47 [95% CI, 1.41-1.54]). Younger age was also a risk factor (adjusted odds ratio, 0.95 [95% CI, 0.94-0.96] per year of increase in age). Earlier study eras were associated with higher CFRs (adjusted odds ratios for 1991-2000, 1.24 [95% CI, 1.13-1.37]; P < .001) compared with 2011 to 2016. Time-trend analysis showed higher CFRs over time in developing countries than developed countries. CONCLUSIONS AND RELEVANCE Despite the declining trend of pediatric severe sepsis and septic shock CFRs, the disparity between developing and developed countries persists. Further characterizations of vulnerable populations and collaborations between developed and developing countries are warranted to reduce the burden of pediatric sepsis globally.

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Epidemiology of sepsis in pediatric intensive care units

Abstract: Sepsis is common in Colombian pediatric intensive care units. Clear risk factors for getting sick and dying from this disease were identified. Mortality resulting from this disease is considerable for a developing society like ours.

Cited by 100 publications

References 36 publications

Global Epidemiology of Pediatric Severe Sepsis: The Sepsis Prevalence, Outcomes, and Therapies Study

Global Epidemiology of Pediatric Severe Sepsis: The Sepsis Prevalence, Outcomes, and Therapies Study

Clinical and epidemiological characteristics of children admitted with fever in emergency department with or without sepsis

Global Case-Fatality Rates in Pediatric Severe Sepsis and Septic Shock

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