Severe sepsis with bacteremia in children in Switzerland-results from the swiss pediatric sepsis study

Abstract

Background and aims Invasive infections represent one of the leading causes of childhood mortality worldwide, accounting for 25% of deaths in PICU. While most studies are based on clinical definitions of sepsis, confirmed bloodstream infection in patients with SIRS remains the gold standard to define bacterial sepsis. We assessed population-based incidence and outcomes of severe sepsis with bacteremia in Switzerland. Methods Multicenter national prospective cohort study including children with blood culture-proven severe sepsis <17 years from 1.9.2011-31.12.2015. Results Out of 1198 bacteremic sepsis episodes, 422 (35%) were classified as severe sepsis including 227/422 (54%) with septic shock. The annual age-standardized incidence rate of severe sepsis with bacteremia was 7.3/100'000 children; with highest rates in neonates (67.1/100'000), and infants (17.7/100'000). Central-line associated blood stream infection (134/422, 32%) and primary bloodstream infection (92/422, 22%) were the most common manifestations. In children beyond the neonatal age, severe sepsis was hospital-acquired in 40% episodes. E. coli (17%), CoNS (14%), S. aureus (12%), GBS (8.5%), S. pneumoniae (7.1%), GAS (4.3%), and N. meningitidis (4.0%), accounted for 67% of severe sepsis episodes. The case fatality rate in severe bacteremic sepsis was significantly higher than the overall case fatality rate (20% versus 7.5%; multivariable OR 37.4, 95%-CI 16.4-108.3). Conclusions This population-based study confirms the burden of bacterial severe sepsis on child health in the era of widespread vaccinations, providing insight into predominant organisms for severe sepsis. There is a need for improved preventive strategies against E. coli and S. aureus which remain responsible for a major proportion of cases.L6138857062017-01-02 <br />