J Pediatr Intensive Care
DOI: 10.1055/s-0044-1789245
Original Article

Comparison of Clinical Characteristics of Viral and Bacterial Sepsis in Children: a Single-Center Retrospective Analysis

1   Department of Pediatric Critical Care, Shizuoka Children's Hospital, Shizuoka, Japan
,
Tatsuya Kawasaki
1   Department of Pediatric Critical Care, Shizuoka Children's Hospital, Shizuoka, Japan
› Author Affiliations
Funding None.

Abstract

Objective This study aimed to elucidate the characteristics of viral sepsis in children by comparing viral and bacterial sepsis.

Methods We conducted a retrospective cohort study in the pediatric intensive care unit (PICU) of a single pediatric hospital. Patients aged <15 years who were admitted for sepsis to the PICU between January 2011 and December 2019 were included. Sepsis was diagnosed according to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) criteria, and the degree of organ dysfunction was evaluated using the Pediatric Sequential Organ Failure Assessment (pSOFA) score. The mortality rate was compared as a primary endpoint between patients with viral sepsis and those with bacterial sepsis.

Results We included 28 patients with viral sepsis and 52 patients with bacterial sepsis. The pSOFA scores for viral and bacterial sepsis were 10 (interquartile range [IQR]: 6.75–14) and 9 (IQR: 7–11) points, respectively, with no significant difference between groups. Respiratory disorders were significantly more prevalent in the viral sepsis group. Mortality between patients with viral (n = 8; 29%) and bacterial (n = 7; 13%) sepsis in the PICU showed no significant difference. When analyses were restricted to patients with septic shock, mortality was significantly higher due to viral (70%) than bacterial (27%) sepsis.

Conclusion In pediatric patients, sepsis due to viral and bacterial infections is associated with similar rates of mortality and organ dysfunction.



Publication History

Received: 07 November 2023

Accepted: 28 July 2024

Article published online:
23 August 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001; 29 (07) 1303-1310
  • 2 Hartman ME, Linde-Zwirble WT, Angus DC, Watson RS. Trends in the epidemiology of pediatric severe sepsis. Pediatr Crit Care Med 2013; 14 (07) 686-693
  • 3 Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003; 348 (16) 1546-1554
  • 4 Iwashyna TJ, Ely EW, Smith DM, Langa KM. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA 2010; 304 (16) 1787-1794
  • 5 Watson RS, Carcillo JA, Linde-Zwirble WT, Clermont G, Lidicker J, Angus DC. The epidemiology of severe sepsis in children in the United States. Am J Respir Crit Care Med 2003; 167 (05) 695-701
  • 6 Carcillo JA. Reducing the global burden of sepsis in infants and children: a clinical practice research agenda. Pediatr Crit Care Med 2005; 6 (3, suppl): S157-S164
  • 7 Weiss SL, Balamuth F, Chilutti M. et al. Identification of pediatric sepsis for epidemiologic surveillance using electronic clinical data. Pediatr Crit Care Med 2020; 21 (02) 113-121
  • 8 Weiss SL, Fitzgerald JC, Pappachan J. et al; Sepsis Prevalence, Outcomes, and Therapies (SPROUT) Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Global epidemiology of pediatric severe sepsis: the sepsis prevalence, outcomes, and therapies study. Am J Respir Crit Care Med 2015; 191 (10) 1147-1157
  • 9 Ruth A, McCracken CE, Fortenberry JD, Hall M, Simon HK, Hebbar KB. Pediatric severe sepsis: current trends and outcomes from the Pediatric Health Information Systems database. Pediatr Crit Care Med 2014; 15 (09) 828-838
  • 10 Southeast Asia Infectious Disease Clinical Research Network. Causes and outcomes of sepsis in southeast Asia: a multinational multicentre cross-sectional study. Lancet Glob Health 2017; 5 (02) e157-e167
  • 11 Singer M, Deutschman CS, Seymour CW. et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 2016; 315 (08) 801-810
  • 12 Matics TJ, Sanchez-Pinto LN. Adaptation and validation of a Pediatric Sequential Organ Failure Assessment score and evaluation of the sepsis-3 definitions in critically ill children. JAMA Pediatr 2017; 171 (10) e172352
  • 13 Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 2013; 48 (03) 452-458
  • 14 Boeddha NP, Schlapbach LJ, Driessen GJ. et al; EUCLIDS consortium. Mortality and morbidity in community-acquired sepsis in European pediatric intensive care units: a prospective cohort study from the European Childhood Life-threatening Infectious Disease Study (EUCLIDS). Crit Care 2018; 22 (01) 143
  • 15 Weiss SL, Peters MJ, Alhazzani W. et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med 2020; 46 (Suppl. 01) 10-67
  • 16 Wiens MO, Larson CP, Kumbakumba E. et al. Application of sepsis definitions to pediatric patients admitted with suspected infections in Uganda. Pediatr Crit Care Med 2016; 17 (05) 400-405
  • 17 Schlapbach LJ, Straney L, Bellomo R, MacLaren G, Pilcher D. Prognostic accuracy of age-adapted SOFA, SIRS, PELOD-2, and qSOFA for in-hospital mortality among children with suspected infection admitted to the intensive care unit. Intensive Care Med 2018; 44 (02) 179-188
  • 18 Schlapbach LJ, Kissoon N. Defining pediatric sepsis. JAMA Pediatr 2018; 172 (04) 312-314
  • 19 Nadel S, Goldstein B, Williams MD. et al; REsearching severe Sepsis and Organ dysfunction in children: a gLobal perspective (RESOLVE) study group. Drotrecogin alfa (activated) in children with severe sepsis: a multicentre phase III randomised controlled trial. Lancet 2007; 369 (9564): 836-843
  • 20 Leteurtre S, Duhamel A, Salleron J, Grandbastien B, Lacroix J, Leclerc F. Groupe Francophone de Réanimation et d'Urgences Pédiatriques (GFRUP). PELOD-2: an update of the PEdiatric logistic organ dysfunction score. Crit Care Med 2013; 41 (07) 1761-1773
  • 21 Leclerc F, Duhamel A, Deken V, Grandbastien B, Leteurtre S. Groupe Francophone de Réanimation et Urgences Pédiatriques (GFRUP). Can the pediatric logistic organ dysfunction-2 score on day 1 be used in clinical criteria for sepsis in children?. Pediatr Crit Care Med 2017; 18 (08) 758-763