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American Academy of Pediatrics
Research Articles

Trends in Epidemiology and Microbiology of Severe Sepsis and Septic Shock in Children

Mukul Sehgal, Hugh J. Ladd and Balagangadhar Totapally
Hospital Pediatrics December 2020, 10 (12) 1021-1030; DOI: https://doi.org/10.1542/hpeds.2020-0174
Mukul Sehgal
aDivision of Pediatric Critical Care Medicine, Nicklaus Children’s Hospital, Miami, Florida;
bDivision of Pediatric Critical Care Medicine, University of South Alabama Children and Women’s Hospital, Mobile, Alabama; and
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Hugh J. Ladd
aDivision of Pediatric Critical Care Medicine, Nicklaus Children’s Hospital, Miami, Florida;
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Balagangadhar Totapally
aDivision of Pediatric Critical Care Medicine, Nicklaus Children’s Hospital, Miami, Florida;
cDepartment of Pediatrics, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
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Abstract

BACKGROUND AND OBJECTIVES: To explore the microbiologic etiology and trends in incidence and survival of nonneonatal pediatric sepsis in the United States by using the 2006, 2009, and 2012 Kids’ Inpatient Database.

METHODS: Children with sepsis were identified by using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for severe sepsis and septic shock (ICD-9-CM cohort) and by the modified Angus method, which incorporates ICD-9-CM codes for infection and organ dysfunction (Angus cohort). Temporal trends in incidence and microbiologic etiology were evaluated.

RESULTS: Among 8 830 057 discharges, 26 470 patients in the ICD-9-CM cohort were diagnosed with severe sepsis and septic shock (29.97 per 10 000 discharges) and 89 505 patients in the Angus cohort (101.34 per 10 000 discharges). The incidence of sepsis increased in both cohorts from 2006 to 2012 (P < .01). In the Angus cohort, the case-fatality rate was the highest for methicillin-resistant Staphylococcus aureus (14.42%, P < .01) among Gram-positive organisms and for Pseudomonas (21.49%; odds ratio: 2.58 [95% confidence interval: 1.88–3.54]; P < .01) among Gram-negative organisms.

CONCLUSIONS: The incidence of sepsis has increased, and the sepsis case-fatality rate has decreased, without a decrease in the overall sepsis-associated mortality rate among hospitalized children. Also, bacterial and fungal organisms associated with the pediatric sepsis have changed over these years. These findings are important for focusing the allocation of health care resources and guiding the direction of future studies.

  • Copyright © 2020 by the American Academy of Pediatrics
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Hospital Pediatrics: 10 (12)
Hospital Pediatrics
Vol. 10, Issue 12
1 Dec 2020
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Trends in Epidemiology and Microbiology of Severe Sepsis and Septic Shock in Children
Mukul Sehgal, Hugh J. Ladd, Balagangadhar Totapally
Hospital Pediatrics Dec 2020, 10 (12) 1021-1030; DOI: 10.1542/hpeds.2020-0174

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Trends in Epidemiology and Microbiology of Severe Sepsis and Septic Shock in Children
Mukul Sehgal, Hugh J. Ladd, Balagangadhar Totapally
Hospital Pediatrics Dec 2020, 10 (12) 1021-1030; DOI: 10.1542/hpeds.2020-0174
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