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)

被引：114

作者：

Boeddha, Navin P. ^{[1
,2
]}

Schlapbach, Luregn J. ^{[3
,4
,5
,6
]}

Driessen, Gertjan J. ^{[2
,7
]}

Herberg, Jethro A. ^{[8
]}

Rivero-Calle, Irene ^{[9
,10
]}

Cebey-Lopez, Miriam ^{[10
]}

Klobassa, Daniela S. ^{[11
]}

Philipsen, Ria ^{[12
,13
,14
]}

de Groot, Ronald ^{[13
]}

Inwald, David P. ^{[15
,16
]}

Nadel, Simon ^{[15
,16
]}

Paulus, Stephane ^{[17
,18
]}

Pinnock, Eleanor ^{[19
]}

Secka, Fatou ^{[20
]}

Anderson, Suzanne T. ^{[20
]}

Agbeko, Rachel S. ^{[21
,22
]}

Berger, Christoph ^{[23
,24
,25
]}

Fink, Colin G. ^{[19
]}

Carrol, Enitan D. ^{[18
]}

Zenz, Werner ^{[11
]}

Levin, Michael ^{[8
]}

van der Flier, Michiel ^{[12
,13
,26
,27
]}

Martinon-Torres, Federico ^{[9
,10
]}

Hazelzet, Jan A. ^{[28
]}

Emonts, Marieke ^{[22
,29
,30
,31
]}

机构：

[1] Erasmus MC, Sophia Childrens Hosp, Univ Med Ctr Rotterdam, Intens Care & Dept Pediat Surg, Wytemaweg 80, NL-3015 CN Rotterdam, Netherlands

[2] Erasmus MC, Sophia Childrens Hosp, Univ Med Ctr Rotterdam, Dept Pediat,Div Pediat Infect Dis & Immunol, Wytemaweg 80, NL-3015 CN Rotterdam, Netherlands

[3] Univ Queensland, Fac Med, Brisbane, Qld 4072, Australia

[4] Univ Queensland, Mater Res Inst, Paediat Crit Care Res Grp, Aubigny Pl,Raymond Terrace, Brisbane, Qld, Australia

[5] Childrens Hlth Queensland, Lady Cilento Childrens Hosp, Paediat Intens Care Unit, 501 Stanley St, Brisbane, Qld, Australia

[6] Univ Bern, Bern Univ Hosp, Inselspital, Dept Pediat, Freiburgstr 8, CH-3010 Bern, Switzerland

[7] Haga Teaching Hosp, Juliana Childrens Hosp, Dept Paediat, Els Borst Eilerspl 275, NL-2545 AA The Hague, Netherlands

[8] Imperial Coll London, Sect Pediat, Level 2,Fac Bldg,South Kensington Campus, London SW7 2AZ, England

[9] Hosp Clin Univ Santiago de Compostela, Pediat Dept, Translat Pediat & Infect Dis Sect, Santiago De Compostela 15706, Spain

[10] Hlth Res Inst Santiago IDIS SERGAS, Genet Vaccines Infect Dis & Pediat Res Grp GENVIP, Santiago De Compostela 15706, Spain

[11] Med Univ Graz, Dept Gen Paediat, Auenbruggerpl 34-2, A-8036 Graz, Austria

[12] Radboudumc, Radboudumc Technol Ctr Clin Studies, Geert Grootepl Zuid 10, NL-6525 GA Nijmegen, Netherlands

[13] Radboudumc, Radboud Inst Mol Life Sci, Sect Pediat Infect Dis, Lab Med Immunol, Geert Grootepl Zuid 10, NL-6525 GA Nijmegen, Netherlands

[14] Radboudumc, Radboud Ctr Infect Dis, Geert Grootepl Zuid 10, NL-6525 GA Nijmegen, Netherlands

[15] Imperial Coll London, Dept Paediat, Fac Med, South Kensington Campus, London SW7 2AZ, England

[16] St Marys Hosp, Imperial Coll Healthcare NHS Trust, Praed St, London W2 1NY, England

[17] Alder Hey Childrens NHS Fdn Trust, Div Paediat Infect Dis, Eaton Rd, Liverpool L12 2AP, Merseyside, England

[18] Univ Liverpool, Inst Infect & Global Hlth, 8 West Derby St, Liverpool L7 3EA, Merseyside, England

[19] Univ Warwick, Micropathol Ltd, Venture Ctr, Sci Pk,Sir William Lyons Rd, Coventry CV4 7EZ, W Midlands, England

[20] MRC Unit, Atlantic Blvd,POB 273, Banjul, Gambia

[21] Royal Victoria Infirm, Great North Childrens Hosp, Newcastle Tyne Hosp NHS Fdn Trust, Dept Paediat Intens Care,Victoria Wing, Newcastle Upon Tyne NE1 4LP, Tyne & Wear, England

[22] Newcastle Univ, Inst Cellular Med, 4th Floor,William Leech Bldg,Framlington Pl, Newcastle Upon Tyne NE2 4HH, Tyne & Wear, England

[23] Univ Childrens Hosp Zurich, Div Infect Dis, Steinwiesenstr 75, CH-8032 Zurich, Switzerland

[24] Univ Childrens Hosp Zurich, Hosp Epidemiol, Steinwiesenstr 75, CH-8032 Zurich, Switzerland

[25] Univ Childrens Hosp Zurich, Childrens Res Ctr, Steinwiesenstr 75, CH-8032 Zurich, Switzerland

[26] Radboudumc, Amalia Childrens Hosp, Pediat Infect Dis & Immunol, Geert Grootepl Zuid 10, NL-6525 GA Nijmegen, Netherlands

[27] Radboudumc, Radboudumc Expertise Ctr Immunodeficiency & Autoi, Geert Grootepl Zuid 10, NL-6525 GA Nijmegen, Netherlands

[28] Erasmus MC, Univ Med Ctr Rotterdam, Dept Publ Hlth, Wytemaweg 80, NL-3015 CN Rotterdam, Netherlands

[29] Royal Victoria Infirm, Newcastle Tyne Hosp NHS Fdn Trust, Paediat Infect Dis & Immunol Dept, Great North Childrens Hosp,Victoria Wing, Newcastle Upon Tyne NE1 4LP, Tyne & Wear, England

[30] Newcastle Tyne Hosp NHS Trust, NIHR Newcastle Biomed Res Ctr, Westgate Rd, Newcastle Upon Tyne NE4 5PL, Tyne & Wear, England

[31] Newcastle Univ, Westgate Rd, Newcastle Upon Tyne NE4 5PL, Tyne & Wear, England

来源：

CRITICAL CARE | 2018年 / 22卷

基金：

瑞士国家科学基金会;

关键词：

Bacteremia; Meningococcal infections; Pneumococcal infections; Mortality; Morbidity; INVASIVE PNEUMOCOCCAL DISEASE; CONJUGATE VACCINE; SEPTIC SHOCK; CHILDREN; EPIDEMIOLOGY; OUTCOMES; BURDEN; PROTECTION; BACTERIAL; SURVIVORS;

D O I：

10.1186/s13054-018-2052-7

中图分类号：

R4 [临床医学];

学科分类号：

100218 [急诊医学];

摘要：

Background: Sepsis is one of the main reasons for non-elective admission to pediatric intensive care units (PICUs), but little is known about determinants influencing outcome. We characterized children admitted with community-acquired sepsis to European PICUs and studied risk factors for mortality and disability. Methods: Data were collected within the collaborative Seventh Framework Programme (FP7)-funded EUCLIDS study, which is a prospective multicenter cohort study aiming to evaluate genetic determinants of susceptibility and/or severity in sepsis. This report includes 795 children admitted with community-acquired sepsis to 52 PICUs from seven European countries between July 2012 and January 2016. The primary outcome measure was in-hospital death. Secondary outcome measures were PICU-free days censured at day 28, hospital length of stay, and disability. Independent predictors were identified by multivariate regression analysis. Results: Patients most commonly presented clinically with sepsis without a source (n = 278, 35%), meningitis/encephalitis (n = 182, 23%), or pneumonia (n = 149, 19%). Of 428 (54%) patients with confirmed bacterial infection, Neisseria meningitidis (n = 131, 31%) and Streptococcus pneumoniae (n = 78, 18%) were the main pathogens. Mortality was 6% (51/795), increasing to 10% in the presence of septic shock (45/466). Of the survivors, 31% were discharged with disability, including 24% of previously healthy children who survived with disability. Mortality and disability were independently associated with S. pneumoniae infections (mortality OR 4.1, 95% CI 1.1-16.0, P = 0.04; disability OR 5.4, 95% CI 1.8-15.8, P < 0.01) and illness severity as measured by Pediatric Index of Mortality (PIM2) score (mortality OR 2.8, 95% CI 1.3-6.1, P < 0.01; disability OR 3.4, 95% CI 1.8-6.4, P < 0.001). Conclusions: Despite widespread immunization campaigns, invasive bacterial disease remains responsible for substantial morbidity and mortality in critically ill children in high-income countries. Almost one third of sepsis survivors admitted to the PICU were discharged with some disability. More research is required to delineate the long-term outcome of pediatric sepsis and to identify interventional targets. Our findings emphasize the importance of improved early sepsis-recognition programs to address the high burden of disease.

引用

页数：13

共 58 条

[1]

Epidemiology of blood culture-proven bacterial sepsis in children in Switzerland: a population-based cohort study [J].