Bacterial and Fungal Etiology of Sepsis in Children in the United States

Autor: Sachin Yende, Victor B. Talisa, Brooke K. Decker, Andrew Prout, Joseph A. Carcillo
Rok vydání: 2020
Předmět:
Male
Methicillin-Resistant Staphylococcus aureus
Staphylococcus aureus
medicine.medical_specialty
Adolescent
Organ Dysfunction Scores
Comorbidity
Critical Care and Intensive Care Medicine
medicine.disease_cause
Severity of Illness Index
Sepsis
03 medical and health sciences
0302 clinical medicine
Internal medicine
medicine
Humans
Pseudomonas Infections
Hospital Mortality
Child
Retrospective Studies
Clostridioides difficile
Pseudomonas aeruginosa
business.industry
Infant
030208 emergency & critical care medicine
Retrospective cohort study
Staphylococcal Infections
Clostridium difficile
medicine.disease
Respiration
Artificial
Shock
Septic
Methicillin-resistant Staphylococcus aureus
United States
Anti-Bacterial Agents
Mycoses
Socioeconomic Factors
030228 respiratory system
Chronic Disease
Clostridium Infections
Etiology
Female
business
Empiric therapy
Zdroj: Critical Care Medicine. 48:e192-e199
ISSN: 0090-3493
DOI: 10.1097/ccm.0000000000004140
Popis: Objectives Timely empiric antimicrobial therapy is associated with improved outcomes in pediatric sepsis, but minimal data exist to guide empiric therapy. We sought to describe the prevalence of four pathogens that are not part of routine empiric coverage (e.g., Staphylococcus aureus, Pseudomonas aeruginosa, Clostridium difficile, and fungal infections) in pediatric sepsis patients in a contemporary nationally representative sample. Design This was a retrospective cohort study using administrative data. Setting We used the Nationwide Readmissions Database from 2014, which is a nationally representative dataset that contains data from nearly half of all discharges from nonfederal hospitals in the United States. Patients Discharges of patients who were less than 19 years old at discharge and were not neonatal with a discharge diagnosis of sepsis. Interventions None. Measurements and main results Of the 19,113 pediatric admissions with sepsis (6,300 [33%] previously healthy and 12,813 [67%] with a chronic disease), 31% received mechanical ventilation, 19% had shock, and 588 (3.1%) died during their hospitalization. Among all admissions, 8,204 (42.9%) had a bacterial or fungal pathogen identified. S. aureus was the most common pathogen identified in previously healthy patients (n = 593, 9.4%) and those with any chronic disease (n = 1,430, 11.1%). Methicillin-resistant S. aureus, P. aeruginosa, C. difficile, and fungal infections all had high prevalence in specific chronic diseases associated with frequent contact with the healthcare system, early surgery, indwelling devices, or immunosuppression. Conclusions In this nationally representative administrative database, the most common identified pathogen was S. aureus in previously healthy and chronically ill children. In addition, a high proportion of children with sepsis and select chronic diseases had infections with methicillin-resistant S. aureus, fungal infections, Pseudomonas infections, and C. difficile. Clinicians caring for pediatric patients should consider coverage of these organisms when administering empiric antimicrobials for sepsis.
Databáze: OpenAIRE
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