J Pediatr Intensive Care 2019; 08(01): 003-010
DOI: 10.1055/s-0038-1676634
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Epidemiology of Pediatric Septic Shock

Daniela Carla de Souza
1   Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Sírio-Libanês, São Paulo, São Paulo, Brazil
2   Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitário da Universidade de São Paulo, São Paulo, São Paulo, Brazil
,
Flávia Ribeiro Machado
3   Department of Anesthesiology, Pain and Intensive Care, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
› Author Affiliations
Further Information

Publication History

01 November 2018

11 November 2018

Publication Date:
28 December 2018 (online)

Abstract

Sepsis, or dysregulated host response to infection, is considered a worldwide public health problem. It is a major childhood disease both in terms of frequency and severity, and severe sepsis is still considered the main cause of death from infection in childhood. This review provides an overview of the epidemiology of pediatric septic shock. The prevalence of severe sepsis and septic shock among hospitalized children ranges from 1 to 26%. Mortality is high, ranging from 5% in developed countries to up to 35% in developing countries. However, 10 years after the publication of pediatric sepsis definitions, a global perspective on the burden of this disease in childhood is still missing. Major obstacles to a better knowledge of sepsis epidemiology in children are the absence of an adequate disease definition and not having sepsis as a cause of death in the World Health Organization Global Burden of Disease Report, which is one of the most important sources of information for health policies decision-making in the world. Several studies performed in both developed and developing countries have shown that mortality from septic shock is high and is associated with delayed diagnosis, late treatment, and nonadherence to the treatment guidelines. Reducing mortality from sepsis in childhood is a worldwide challenge, especially in developing countries, where the highest number of cases and deaths are recorded and where financial resources are scarce. Many specialists consider that prevention, education, and organization are key to achieve a reduction in the burden of sepsis.

 
  • References

  • 1 Reinhart K, Daniels R, Kissoon N, Machado FR, Schachter RD, Finfer S. Recognizing sepsis as a global health priority - a WHO resolution. N Engl J Med 2017; 377 (05) 414-417
  • 2 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
  • 3 Brierley J, Carcillo JA, Choong K. , et al. Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Crit Care Med 2009; 37 (02) 666-688
  • 4 Kissoon N, Carcillo JA, Espinosa V. , et al; Global Sepsis Initiative Vanguard Center Contributors. World Federation of Pediatric Intensive Care and Critical Care Societies: global sepsis initiative. Pediatr Crit Care Med 2011; 12 (05) 494-503
  • 5 Dellinger RP, Levy MM, Rhodes A. , et al; Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 2013; 41 (02) 580-637
  • 6 Davis AL, Carcillo JA, Aneja RK. , et al. American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock. Crit Care Med 2017; 45 (06) 1061-1093
  • 7 Liu L, Oza S, Hogan D. , et al. Global, regional, and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet 2015; 385 (9966): 430-440
  • 8 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
  • 9 Bone RC, Balk RA, Cerra FB. , et al; The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 1992; 101 (06) 1644-1655
  • 10 Proulx F, Fayon M, Farrell CA, Lacroix J, Gauthier M. Epidemiology of sepsis and multiple organ dysfunction syndrome in children. Chest 1996; 109 (04) 1033-1037
  • 11 Kutko MC, Calarco MP, Flaherty MB. , et al. Mortality rates in pediatric septic shock with and without multiple organ system failure. Pediatr Crit Care Med 2003; 4 (03) 333-337
  • 12 Leclerc F, Leteurtre S, Duhamel A. , et al. Cumulative influence of organ dysfunctions and septic state on mortality of critically ill children. Am J Respir Crit Care Med 2005; 171 (04) 348-353
  • 13 Sáez-Llorens X, Vargas S, Guerra F, Coronado L. Application of new sepsis definitions to evaluate outcome of pediatric patients with severe systemic infections. Pediatr Infect Dis J 1995; 14 (07) 557-561
  • 14 Goh A, Lum L. Sepsis, severe sepsis and septic shock in paediatric multiple organ dysfunction syndrome. J Paediatr Child Health 1999; 35 (05) 488-492
  • 15 Tantaleán JA, León RJ, Santos AA, Sánchez E. Multiple organ dysfunction syndrome in children. Pediatr Crit Care Med 2003; 4 (02) 181-185
  • 16 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
  • 17 Hayden WR. Sepsis terminology in pediatrics. J Pediatr 1994; 124 (04) 657-658
  • 18 Bone RC, Balk RA, Cerra FB. , et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. 1992. Chest 2009; 136: e28
  • 19 Goldstein B, Giroir B, Randolph A. ; International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005; 6 (01) 2-8
  • 20 Balamuth F, Weiss SL, Neuman MI. , et al. Pediatric severe sepsis in U.S. children's hospitals. Pediatr Crit Care Med 2014; 15 (09) 798-805
  • 21 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
  • 22 Thompson GC, Kissoon N. Sepsis in Canadian children: a national analysis using administrative data. Clin Epidemiol 2014; 6: 461-469
  • 23 Wolfler A, Silvani P, Musicco M, Antonelli M, Salvo I. ; Italian Pediatric Sepsis Study (SISPe) group. Incidence of and mortality due to sepsis, severe sepsis and septic shock in Italian Pediatric Intensive Care Units: a prospective national survey. Intensive Care Med 2008; 34 (09) 1690-1697
  • 24 Shime N, Kawasaki T, Saito O. , et al. Incidence and risk factors for mortality in paediatric severe sepsis: results from the national paediatric intensive care registry in Japan. Intensive Care Med 2012; 38 (07) 1191-1197
  • 25 Schlapbach LJ, Straney L, Alexander J. , et al; ANZICS Paediatric Study Group. 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. Lancet Infect Dis 2015; 15 (01) 46-54
  • 26 Vila Pérez D, Jordan I, Esteban E. , et al. Prognostic factors in pediatric sepsis study, from the Spanish Society of Pediatric Intensive Care. Pediatr Infect Dis J 2014; 33 (02) 152-157
  • 27 Agyeman PKA, Schlapbach LJ, Giannoni E. , et al; Swiss Pediatric Sepsis Study. Epidemiology of blood culture-proven bacterial sepsis in children in Switzerland: a population-based cohort study. Lancet Child Adolesc Health 2017; 1 (02) 124-133
  • 28 Mangia CM, Kissoon N, Branchini OA, Andrade MC, Kopelman BI, Carcillo J. Bacterial sepsis in Brazilian children: a trend analysis from 1992 to 2006. PLoS One 2011; 6 (06) e14817
  • 29 Wang Y, Sun B, Yue H. , et al. An epidemiologic survey of pediatric sepsis in regional hospitals in China. Pediatr Crit Care Med 2014; 15 (09) 814-820
  • 30 de Souza DC, Shieh HH, Barreira ER, Ventura AM, Bousso A, Troster EJ. ; LAPSES Group. Epidemiology of sepsis in children admitted to PICUs in South America. Pediatr Crit Care Med 2016; 17 (08) 727-734
  • 31 Jaramillo-Bustamante JC, Marín-Agudelo A, Fernández-Laverde M, Bareño-Silva J. Epidemiology of sepsis in pediatric intensive care units: first Colombian multicenter study. Pediatr Crit Care Med 2012; 13 (05) 501-508
  • 32 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
  • 33 Fleischmann-Struzek C, Goldfarb DM, Schlattmann P, Schlapbach LJ, Reinhart K, Kissoon N. The global burden of paediatric and neonatal sepsis: a systematic review. Lancet Respir Med 2018; 6 (03) 223-230
  • 34 Kissoon N, Argent A, Devictor D. , et al. World Federation of Pediatric Intensive and Critical Care Societies-its global agenda. Pediatr Crit Care Med 2009; 10 (05) 597-600
  • 35 Cvetkovic M, Lutman D, Ramnarayan P, Pathan N, Inwald DP, Peters MJ. Timing of death in children referred for intensive care with severe sepsis: implications for interventional studies. Pediatr Crit Care Med 2015; 16 (05) 410-417
  • 36 Gaieski DF, Edwards JM, Kallan MJ, Carr BG. Benchmarking the incidence and mortality of severe sepsis in the United States. Crit Care Med 2013; 41 (05) 1167-1174
  • 37 Weiss SL, Parker B, Bullock ME. , et al. Defining pediatric sepsis by different criteria: discrepancies in populations and implications for clinical practice. Pediatr Crit Care Med 2012; 13 (04) e219-e226
  • 38 Weiss SL, Fitzgerald JC, Maffei FA. , et al; SPROUT Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network. Discordant identification of pediatric severe sepsis by research and clinical definitions in the SPROUT international point prevalence study. Crit Care 2015; 19: 325
  • 39 Souza DC, Brandão MB, Piva JP. From the International Pediatric Sepsis Conference 2005 to the Sepsis-3 Consensus. Rev Bras Ter Intensiva 2018; 30 (01) 1-5
  • 40 GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015; 385 (9963): 117-171
  • 41 Kissoon N, Uyeki TM. Sepsis and the global burden of disease in children. JAMA Pediatr 2016; 170 (02) 107-108
  • 42 Schlapbach LJ, Kissoon N. Defining pediatric sepsis. JAMA Pediatr 2018; 172 (04) 312-314
  • 43 Piva JP, Garcia PC. Sepsis: from the stone age to nowadays without a precise definition. Pediatr Crit Care Med 2016; 17 (08) 794-795
  • 44 Oliveira CF, Nogueira de Sá FR, Oliveira DS. , et al. Time- and fluid-sensitive resuscitation for hemodynamic support of children in septic shock: barriers to the implementation of the American College of Critical Care Medicine/Pediatric Advanced Life Support Guidelines in a pediatric intensive care unit in a developing world. Pediatr Emerg Care 2008; 24 (12) 810-815
  • 45 Ninis N, Phillips C, Bailey L. , et al. The role of healthcare delivery in the outcome of meningococcal disease in children: case-control study of fatal and non-fatal cases. BMJ 2005; 330 (7506): 1475
  • 46 Weiss SL, Balamuth F, Hensley J. , et al. The epidemiology of hospital death following pediatric severe sepsis: when, why, and how children with sepsis die. Pediatr Crit Care Med 2017; 18 (09) 823-830
  • 47 Kissoon N. Sepsis guideline implementation: benefits, pitfalls and possible solutions. Crit Care 2014; 18 (02) 207
  • 48 Nadel S, Britto J, Booy R, Maconochie I, Habibi P, Levin M. Avoidable deficiencies in the delivery of health care to children with meningococcal disease. J Accid Emerg Med 1998; 15 (05) 298-303
  • 49 Kissoon N. Sepsis guidelines: suggestions to improve adherence. J Infect 2015; 71 (Suppl. 01) S36-S41
  • 50 Assunção M, Akamine N, Cardoso GS. , et al; SEPSES Study Group. Survey on physicians' knowledge of sepsis: do they recognize it promptly?. J Crit Care 2010; 25 (04) 545-552
  • 51 Santhanam I, Kissoon N, Kamath SR, Ranjit S, Ramesh J, Shankar J. GAP between knowledge and skills for the implementation of the ACCM/PALS septic shock guidelines in India: is the bridge too far?. Indian J Crit Care Med 2009; 13 (02) 54-58
  • 52 Noritomi DT, Ranzani OT, Monteiro MB. , et al. Implementation of a multifaceted sepsis education program in an emerging country setting: clinical outcomes and cost-effectiveness in a long-term follow-up study. Intensive Care Med 2014; 40 (02) 182-191
  • 53 Ferrer R, Artigas A, Levy MM. , et al; Edusepsis Study Group. Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain. JAMA 2008; 299 (19) 2294-2303
  • 54 Booy R, Habibi P, Nadel S. , et al; Meningococcal Research Group. Reduction in case fatality rate from meningococcal disease associated with improved healthcare delivery. Arch Dis Child 2001; 85 (05) 386-390
  • 55 Larsen GY, Mecham N, Greenberg R. An emergency department septic shock protocol and care guideline for children initiated at triage. Pediatrics 2011; 127 (06) e1585-e1592
  • 56 Balamuth F, Weiss SL, Fitzgerald JC. , et al. Protocolized treatment is associated with decreased organ dysfunction in pediatric severe sepsis. Pediatr Crit Care Med 2016; 17 (09) 817-822
  • 57 Akcan Arikan A, Williams EA, Graf JM, Kennedy CE, Patel B, Cruz AT. Resuscitation bundle in pediatric shock decreases acute kidney injury and improves outcomes. J Pediatr 2015; 167 (06) 1301-5.e1
  • 58 Cruz AT, Perry AM, Williams EA, Graf JM, Wuestner ER, Patel B. Implementation of goal-directed therapy for children with suspected sepsis in the emergency department. Pediatrics 2011; 127 (03) e758-e766
  • 59 Paul R, Neuman MI, Monuteaux MC, Melendez E. Adherence to PALS sepsis guidelines and hospital length of stay. Pediatrics 2012; 130 (02) e273-e280
  • 60 Paul R, Melendez E, Stack A, Capraro A, Monuteaux M, Neuman MI. Improving adherence to PALS septic shock guidelines. Pediatrics 2014; 133 (05) e1358-e1366