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- Demet Demirkol (Turkey)
- Akash Deep (United Kingdom)
EXTRACORPOREAL ENDOTOXIN REMOVAL FOR SEPSIS
- Stuart L. Goldstein (United States of America)
REVIEW OF MORTALITY IN IMMUNOCOMPROMISED CHILDREN DUE TO SEPTIC SHOCK ASSOCIATED WITH MULTI-DRUG RESISTANT ORGANISMS: CASE SERIES
- Sudivya Sharma (India)
Abstract
Background and Aims
Mortality and morbidity of septic shock in immunocompromised children is high. We aim to understand its causal and modifiable factors for quality improvement by reviewing three month’s mortality of children admitted in our intensive care.
Methods
We prospectively reviewed the three month mortality in children with cancer admitted to the intensive care unit of a tertiary care centre. Sepsis is the leading cause of morbidity and mortality in this cohort. We studied the microbiology data of isolates from blood, respiratory tract, wound, and drain; along with their sensitivity pattern to antibiotics. Every mortality was discussed in multidisciplinary meeting to highlight areas of improvement including trigger criteria to shift the child to ICU, optimal resuscitation, management of septic shock, choice of antibiotic, source control, organ support, etc.
Results
Out of 125 admissions, 18.4 % of children died in the ICU. Children admitted for medical reasons had worse outcome as opposed to those admitted post surgery. The most common cause of death was septic shock with considerable proportion of neutropenic sepsis. Multidrug resistant Eisherichia coli and klebsiella pneumonia were the most frequent isolates followed by pseudomonas and enterococcus species. These were most sensitive to ceftriaxone-sulbactam-EDTA and tigecycline. The gram positive cocci were sensitive to cefotaxime, linezolid and teicoplanin.
Conclusions
There is predominance of gram negative sepsis in cancer patients with multidrug resistant isolates.The study of common isolates, their sensitivity patterns, success of clearance and patient outcomes can guide our future choice of empirical antibiotic. Early identification and appropriate resuscitation are critical for better outcomes in paediatric critical care unit.