Characteristics and Outcomes of Culture-Positive and Culture-Negative Pediatric Sepsis.

Autor: Baker AH; Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Harvard University, Boston, MA. Electronic address: alexandra.baker@childrens.harvard.edu., Leland SB; Department of Pediatrics, Harvard Medical School, Harvard University, Boston, MA; Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA., Freiman E; Department of Emergency Medicine, Newton Wellesley Hospital, Newton, MA., Herigon JC; Division of Infectious Diseases, Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO; Department of Pediatrics, University of Missouri - Kansas City School of Medicine, University of Missouri, Kansas City, MO., Eisenberg MA; Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Harvard University, Boston, MA.
Jazyk: angličtina
Zdroj: The Journal of pediatrics [J Pediatr] 2023 Dec; Vol. 263, pp. 113718. Date of Electronic Publication: 2023 Aug 31.
DOI: 10.1016/j.jpeds.2023.113718
Abstrakt: Objectives: To compare the outcomes of pediatric severe sepsis and septic shock among patients with culture-positive and culture-negative sepsis and to determine if there are differentiating markers of disease severity between these 2 populations during their initial presentation and emergency department (ED) stay.
Study Design: Retrospective cohort study of patients ≤21 years of age who presented to the ED of a single children's hospital with severe sepsis or septic shock from June 1, 2017 to June 5, 2019.
Results: There were 235 patients who met criteria for severe sepsis or septic shock. Of these, 139 (59.1%) had culture-negative sepsis and 96 (40.9%) had culture-positive sepsis. In the adjusted multivariable model, children with culture-negative sepsis had more intensive care unit (ICU)-free days than those with culture-positive sepsis (27.3 vs 24.1; adjusted median differences [aMD] -2.6 [-4.4, -0.8]). There were no differences in mortality or hospital-free days. On initial presentation, there were no differences in fever, hypothermia, tachycardia, tachypnea, or hypotension between the 2 groups. There were no differences in proportion of patients receiving the following interventions: intravenous (IV) antibiotics, IV fluids, vasoactive medications, CPR, intubation, or time from arrival to provision of these interventions.
Conclusions: Culture-negative sepsis constitutes a substantial proportion of pediatric severe sepsis and septic shock. In this study, patients with culture-negative and culture-positive sepsis presented similarly on arrival to the ED and received similar treatments while there. Patients with culture-negative sepsis had more ICU-free days than those with culture-positive sepsis, although differences in hospital length of stay (LOS) and mortality were not observed.
Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to disclose. No funding was secured for this study.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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