OUR EXPERIENCE IN PEDIATRIC SEPSIS

Despite the existence of an international consensus regarding both pediatric sepsis-related definitions, and the management of this serious condition, there is no detailed analysis of the epidemiology, diagnosis and prognosis of pediatric sepsis n Romania. We sought to determine the influence of age, gender, microbiologic etiology, and underlying condition on the incidence, outcome, and associated hospital resources use of sepsis and its complications in pediatric patients. We analyzed our Clinic’s patients’ files for the years 2003 and 2004. Of 2876 hospitalizations for an infectious process in children, 248met the International Pediatric Sepsis Consensus Conference definitions for sepsis, or 124 cases of pediatric sepsis per year. The incidence was highest in infants (12 per 100 infected children) and fell constantly with age. The incidence of sepsis in children did not vary significantly by sex in any of the age groups. One third of the cases had underlying disease (33%). The majority of infections causing sepsis were respiratory (64%). Microbiologic etiology was determined in 25% of all cases, with Gramnegative bacteria being the most important pathogens. Hospital mortality was 5% overall, with a mortality of 53%for the patients presenting with septic shock. The mean length of stay was 12 days. Several factors were significantly associated (p<0.005) with a poor outcome: shock, metabolic acidosis, increased serum bilirubin and creatinine levels, the presence of 4 or more organ dysfunctions. The therapy with corticosteroids was found to improve the outcome of pediatric patients with severe sepsis or septic shock. Sepsis is a significant healthcare problem in children and is associated with the use of extensive healthcare resources. We therefore need to make efforts to increase awareness and adopt the existing evidence-based recommendations for the management of sepsis and its complications.