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Epidemiology of Pediatric Severe Sepsis in Main PICU Centers in Southwest China.
Pediatr Crit Care Med. 2019 12; 20(12):1118-1125.PC

Abstract

OBJECTIVES

To estimate the prevalence, management, and outcomes of pediatric severe sepsis in the main PICUs in Southwest China.

DESIGN

A prospective, observational, and multicenter study.

SETTING

Eight PICUs in Southwest China with 19 (13-24) beds and 1,322 (1,066-1,452) annual admissions each.

PATIENTS

A total of 10,598 patients (29 d to 18 yr old) were consecutively admitted between September 1, 2016, and August 31, 2017. All patients were screened and evaluated for severe sepsis or septic shock. Of them, 10,353 patients were excluded due to incomplete data or not meeting the consensus criteria for severe sepsis or septic shock; 245 patients were included with complete data.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Finally, 245 patients who were diagnosed with severe sepsis or septic shock were included in the study, with an incidence rate of 2.3%. Of them, 64.0% of the enrolled patients were male with 80.8% being less than 5 years old and 60.8% being from rural areas. The respiratory system was the most common organ system in which dysfunction was observed (76.7%) as well as the most frequently infected site (37.6%). The primary therapies were antibiotics (99.0%), immunoglobulin (88.3%), mechanical ventilation (78.4%), vasoactive infusions (59.6%), and corticosteroids (46.1%). Among the 188 patients who had respiratory dysfunction, 173(92%) required mechanical ventilation and 39 (20.7%) met the criteria for pediatric acute respiratory distress syndrome. Seven of the patients with pediatric acute respiratory distress syndrome died (7/39, 17.9%). The median durations for mechanical ventilation and vasoactive medications were 123.5 hours (35.25-226.00 hr) and 2 days (1-5 d), respectively. Eighty-six percent of patients had multiple organ dysfunction syndrome at the point at which severe sepsis was recognized, and 31% had underlying conditions. The hospital mortality rate was 18.8%.

CONCLUSIONS

This report is the first to present the prevalence, treatment, and outcomes of pediatric severe sepsis in the main PICU centers in Southwest China. The mortality rate remains high; therefore, improved clinical management and implementation of large-scale clinical trials are necessary to improve early diagnoses and treatment.

Authors+Show Affiliations

Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China. Department of Pediatric Critical Care, Children's Hospital of Chongqing Medical University, Chongqing, China.Department of Pediatric Critical Care, Kunming Children's Hospital, Kunming, China.Department of Pediatric Critical Care, Kunming Children's Hospital, Kunming, China.Department of Pediatric Critical Care, Chengdu Women and Children's Central Hospital, Chengdu, Sichuan, China.Department of Pediatric Critical Care, Chengdu Women and Children's Central Hospital, Chengdu, Sichuan, China.Department of Pediatrics, Chongqing Three Gorges Women and Children's Hospital, Wanzhou, Chongqing, China.Department of Pediatric Critical Care, The First People's Hospital of ZunYi, Zunyi, Guizhou, China.Department of Pediatric Critical Care, The First People's Hospital of ZunYi, Zunyi, Guizhou, China.Department of Pediatric Critical Care, Guiyang Children's Hospital, Guiyang, Guizhou, China.Department of Pediatric Critical Care, Guiyang Children's Hospital, Guiyang, Guizhou, China.Department of Pediatric Critical Care, Mianyang Central Hospital, Mianyang, Sichuan, China.Department of Pediatric Critical Care, Mianyang Central Hospital, Mianyang, Sichuan, China.Department of Pediatric Critical Care, Chongqing Qijiang People's Hospital, Qijiang, Chongqing, China.Department of Pediatric Critical Care, Chongqing Qijiang People's Hospital, Qijiang, Chongqing, China.

Pub Type(s)

Journal Article
Multicenter Study
Observational Study

Language

eng

PubMed ID

31261227

Citation

Xiao, Changxue, et al. "Epidemiology of Pediatric Severe Sepsis in Main PICU Centers in Southwest China." Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, vol. 20, no. 12, 2019, pp. 1118-1125.
Xiao C, Wang S, Fang F, et al. Epidemiology of Pediatric Severe Sepsis in Main PICU Centers in Southwest China. Pediatr Crit Care Med. 2019;20(12):1118-1125.
Xiao, C., Wang, S., Fang, F., Xu, F., Xiao, S., Li, B., Zhang, G., Luo, X., Jiang, J., Huang, B., Chen, Y., Chen, J., Wang, H., Yu, J., Ren, D., Ren, X., & Tang, C. (2019). Epidemiology of Pediatric Severe Sepsis in Main PICU Centers in Southwest China. Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 20(12), 1118-1125. https://doi.org/10.1097/PCC.0000000000002079
Xiao C, et al. Epidemiology of Pediatric Severe Sepsis in Main PICU Centers in Southwest China. Pediatr Crit Care Med. 2019;20(12):1118-1125. PubMed PMID: 31261227.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Epidemiology of Pediatric Severe Sepsis in Main PICU Centers in Southwest China. AU - Xiao,Changxue, AU - Wang,Sa, AU - Fang,Fang, AU - Xu,Feng, AU - Xiao,Shufang, AU - Li,Bin, AU - Zhang,Guoying, AU - Luo,Xiaoli, AU - Jiang,Jianyu, AU - Huang,Bo, AU - Chen,Yu, AU - Chen,Jianli, AU - Wang,Huazhu, AU - Yu,Jing, AU - Ren,Dan, AU - Ren,Xiaoling, AU - Tang,Chenxi, PY - 2019/7/2/pubmed PY - 2020/8/29/medline PY - 2019/7/2/entrez SP - 1118 EP - 1125 JF - Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies JO - Pediatr Crit Care Med VL - 20 IS - 12 N2 - OBJECTIVES: To estimate the prevalence, management, and outcomes of pediatric severe sepsis in the main PICUs in Southwest China. DESIGN: A prospective, observational, and multicenter study. SETTING: Eight PICUs in Southwest China with 19 (13-24) beds and 1,322 (1,066-1,452) annual admissions each. PATIENTS: A total of 10,598 patients (29 d to 18 yr old) were consecutively admitted between September 1, 2016, and August 31, 2017. All patients were screened and evaluated for severe sepsis or septic shock. Of them, 10,353 patients were excluded due to incomplete data or not meeting the consensus criteria for severe sepsis or septic shock; 245 patients were included with complete data. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Finally, 245 patients who were diagnosed with severe sepsis or septic shock were included in the study, with an incidence rate of 2.3%. Of them, 64.0% of the enrolled patients were male with 80.8% being less than 5 years old and 60.8% being from rural areas. The respiratory system was the most common organ system in which dysfunction was observed (76.7%) as well as the most frequently infected site (37.6%). The primary therapies were antibiotics (99.0%), immunoglobulin (88.3%), mechanical ventilation (78.4%), vasoactive infusions (59.6%), and corticosteroids (46.1%). Among the 188 patients who had respiratory dysfunction, 173(92%) required mechanical ventilation and 39 (20.7%) met the criteria for pediatric acute respiratory distress syndrome. Seven of the patients with pediatric acute respiratory distress syndrome died (7/39, 17.9%). The median durations for mechanical ventilation and vasoactive medications were 123.5 hours (35.25-226.00 hr) and 2 days (1-5 d), respectively. Eighty-six percent of patients had multiple organ dysfunction syndrome at the point at which severe sepsis was recognized, and 31% had underlying conditions. The hospital mortality rate was 18.8%. CONCLUSIONS: This report is the first to present the prevalence, treatment, and outcomes of pediatric severe sepsis in the main PICU centers in Southwest China. The mortality rate remains high; therefore, improved clinical management and implementation of large-scale clinical trials are necessary to improve early diagnoses and treatment. SN - 1529-7535 UR - https://www.unboundmedicine.com/medline/citation/31261227/Epidemiology_of_Pediatric_Severe_Sepsis_in_Main_PICU_Centers_in_Southwest_China_ L2 - https://doi.org/10.1097/PCC.0000000000002079 DB - PRIME DP - Unbound Medicine ER -