Early recognition of high-risk sepsis patients is crucial for enrolment in trials, and to select patients for targeted therapies. The pediatric sepsis score is a prediction model for sepsis mortality, using a simple set of variables available within 60mins of ICU admission (Schlapbach LJ et al. Intensive Care Med.2017 Aug;43(8):1085-1096).
We aimed to validate this score in an independent cohort.
Retrospective multicenter cohort study based on prospectively collected data from the Dutch Pediatric Intensive Care Evaluation (PICE) registry. We included patients <16 years admitted with sepsis and/or septic shock to PICU from 2003-2016. The pediatric sepsis score was calculated using variables available at PICU admission. Lactate data was not available. The primary outcome was mortality and secondary outcome was mortality and/or PICU length of stay (LOS) ≥72h.
We included 1929 admissions for sepsis and septic shock (57% male; median age 2.2y; IQR 6m-8.2y), of which 257/1929 (13.3%) died and 1162/1929 (60.2%) admissions resulted in mortality and/or PICU LOS ≥72h. Both primary and secondary outcome strongly correlated with the sepsis score (p<0.001). The pediatric sepsis score predicted mortality with an AUC of 0.698 (95%-CI 0.677-0.718) and mortality/PICU LOS ≥72h with an AUC of 0.711 (95%-CI 0.690-0.731).
Validation of the pediatric sepsis score in an independent dataset demonstrates that it is a robust tool to predict mortality, and mortality and/or prolonged ICU stay in children admitted to PICU with sepsis. The lack of lactate data in the validation dataset may have contributed to the lower predictive performance compared to the original study.
Pediatric severe sepsis remains a major public health problem. However, the prevalence, clinical characteristics, and management of pediatric severe sepsis in Asia is rarely described.
To identify the prevalence, risk factors, treatment and outcomes of children with sepsis in PICU
This is a multicenter retrospective study of children with severe sepsis who were admitted in pediatric intensive care unit (PICU) from January – December, 2017. We included children with severe sepsis or septic shock based on the American College of Critical Care Medicine’s definition.
:Five PICUs in Pediatric Acute & Critical Care Medicine Asian Network participated in this study (Thailand, Singapore, Malaysia). 188 children were included in this study. Mean age was 4.8 ± 5.0 years. 64 (42%) had underlying disease. Pneumonia [39, 34%] was the most common source of infection. 136 (93.8%) patients were resuscitated within the first hour and 108 (72.6%) received fluid bolus after diagnosis of shock. Normal saline (72, 67.9%) was the most common first fluid used for resuscitation, followed by ringer lactate/Acetar (14, 13%) and 5% albumin (4, 3.7%). 106(72.6%) patients received first vasopressor at first hour of resuscitation and dopamine was the most common vasopressor (57, 53.7%) used. Antibiotics were given within 1 hr in 147 (98%) patients. Corticosteroids was given in 45 (40.2%) patients. Duration of PICU stay was 12.6 ± 29.7 days. Overall 28-day mortality was at 30/127 (23.6%).
Children admitted with severe sepsis and septic shock in Asian PICU had high mortality
Although there are studies in different age groups regarding the infusion of polyclonal IgM-enriched intravenous immunoglobin (Pentaglobin) in the treatment of sepsis, data on use in pediatric intensive care units are limited.
The aim of this study was to evaluate clinical features and prognosis of children receiving Pentaglobin in the pediatric infectious disease unit due to serious infections.
We evaluated medical records of 254 children (aged between 1-216 months), receiving Pentaglobin infusion (104 children for 3 days,150 children for 5 days) in addition to standard treatment between 2010-2017.
The mortality rate was lower in patients receiving Pentaglobin for 5-days comparing the patients receiving for 3-days (p<0.05). We observed a decreased mortality rate in 5-days group in children with sepsis, septic shock, and multi-organ failure groups, whereas the statistical significance has been only observed in septic shock group(p<0.05). According to the microbiological results, decreased mortality rate has been observed in all patients receiving 5-days treatment, while the statistical difference has been only observed for the infections due to Gram-negative pathogens(p<0.05). Statistical significance has been observed among children aged between 1-24 months between 5-days and 3-days group (p<0.05).
Polyclonal IgM-enriched immunoglobulin for 5-days as an adjuvant treatment for the serious infectious disease in the pediatric intensive care unit, showed a significant reduction for mortality in septic shock cases. The effect was shown to be more pronounced for gram-negative infections and for the 1-24-months age group. Prospective randomized controlled trials needed to support these results.
Surveillance of health care-associated infections (HAIs) plays a key role in infection control and management.
To identify the incidence of 3 device-associated HAIs (DA-HAIs) in pediatric intensive care units (PICUs) in Greece: catheter-related bloodstream infection (CRI), intubation-associated pneumonia (IAP) and catheter-associated urinary tract infection (CAUTI).
Prospective surveillance study (July-December 2017) was conducted in four PICUs in Greece using European Centre for Disease Prevention and Control(ECDC) HAI-net ICU protocol, version 2.2. Included patients were admitted for >48 hours to PICU. Medical records were assessed daily. Patient–days, device-days, demographics, severity illness score, susceptibility of isolated pathogens, and outcome were recorded.
153 children were included with median age 4 years (IQR, 1-9), 88 (57.5%) male, median PRISM III 5 (IQR, 3-8), and median length of stay (LOS) 7 days (IQR, 4-15). Crude mortality was 7.8%. Device utilization rates of central line, intubation devices and urinary catheters were 0.79, 0.65, and 0.70, respectively. CRI, IAP and CAUTI rates were 2.32, 10.5 and 4.6 per 1,000device-days. 14(35%) microbiologically confirmed blood stream infections (BSI) out of 40 HAIs were of unknown origin. Patients with DA-HAIs had greater severity score (p<0.001) and increased LOS (28.5 vs 6 days, p<0.001). Enterobacteriae spp(16/40) were the most commonly found pathogens. Carbapenem resistance was 43.8% for Klebsiella pneumoniae, 33.3% for Pseudomonas aeruginosa and 80% for Acinetobacter baumanii.
Active surveillance of DA-HAIs has never been performed in a multicentre PICU setting in Greece. DA-HAIs incidence and isolate resistance rates stress the need for infection control bundles and antimicrobial stewardship interventions.