Mortality related to invasive infections, sepsis, and septic shock in critically ill children in Australia and New Zealand, 2002-13: a multicentre retrospective cohort study

Schlapbach, Luregn J., Straney, Lahn, Alexander, Janet, MacLaren, Graeme, Festa, Marino, Schibler, Andreas and Slater, Anthony (2015) Mortality related to invasive infections, sepsis, and septic shock in critically ill children in Australia and New Zealand, 2002-13: a multicentre retrospective cohort study. The Lancet Infectious Diseases, 15 1: 46-54. doi:10.1016/S1473-3099(14)71003-5


Author Schlapbach, Luregn J.
Straney, Lahn
Alexander, Janet
MacLaren, Graeme
Festa, Marino
Schibler, Andreas
Slater, Anthony
Title Mortality related to invasive infections, sepsis, and septic shock in critically ill children in Australia and New Zealand, 2002-13: a multicentre retrospective cohort study
Journal name The Lancet Infectious Diseases   Check publisher's open access policy
ISSN 1474-4457
1473-3099
Publication date 2015-01-01
Year available 2014
Sub-type Article (original research)
DOI 10.1016/S1473-3099(14)71003-5
Volume 15
Issue 1
Start page 46
End page 54
Total pages 9
Place of publication London United Kingdom
Publisher The Lancet Publishing Group
Collection year 2015
Language eng
Formatted abstract
Background

Severe infections kill more than 4·5 million children every year. Population-based data for severe infections in children requiring admission to intensive care units (ICUs) are scarce. We assessed changes in incidence and mortality of severe infections in critically ill children in Australia and New Zealand.

Methods

We did a retrospective multicentre cohort study of children requiring intensive care in Australia and New Zealand between 2002 and 2013, with data from the Australian and New Zealand Paediatric Intensive Care Registry. We included children younger than 16 years with invasive infection, sepsis, or septic shock. We assessed incidence and mortality in the ICU for 2002–07 versus 2008–13.

Findings

During the study period, 97 127 children were admitted to ICUs, 11 574 (11·9%) had severe infections, including 6688 (6·9%) with invasive infections, 2847 (2·9%) with sepsis, and 2039 (2·1%) with septic shock. Age-standardised incidence increased each year by an average of 0·56 cases per 100 000 children (95% CI 0·41–0·71) for invasive infections, 0·09 cases per 100 000 children (0·00–0·17) for sepsis, and 0·08 cases per 100 000 children (0·04–0·12) for septic shock. 260 (3·9%) of 6688 patients with invasive infection died, 159 (5·6%) of 2847 with sepsis died, and 346 (17·0%) of 2039 with septic shock died, compared with 2893 (3·0%) of all paediatric ICU admissions. Children admitted with invasive infections, sepsis, and septic shock accounted for 765 (26·4%) of 2893 paediatric deaths in ICUs. Comparing 2008–13 with 2002–07, risk-adjusted mortality decreased significantly for invasive infections (odds ratio 0·72, 95% CI 0·56–0·94; p=0·016), and for sepsis (0·66, 0·47–0·93; p=0·016), but not significantly for septic shock (0·79, 0·61–1·01; p=0·065).

Interpretation

Severe infections remain a major cause of mortality in paediatric ICUs, representing a major public health problem. Future studies should focus on patients with the highest risk of poor outcome, and assess the effectiveness of present sepsis interventions in children.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published online ahead of print 1 Dec 2014

Document type: Journal Article
Sub-type: Article (original research)
Collections: Mater Research Institute-UQ (MRI-UQ)
Official 2015 Collection
School of Medicine Publications
 
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