Table 1
Most common comorbidities in children with sepsis in non-resource-limited settings
SEPSIS in Children
Sepsis arises when the body is invaded by an infection, prompting the immune system to fight it.
In response, the immune system becomes hyperactive and targets the body’s organs and tissues. This can result in harm to vital organs such as the kidneys, lungs, brain, and heart, potentially leading to fatal consequences. The best chance of getting better from sepsis is early intervention.
Key Points
- Sepsis contributes to 19% of all deaths globally, with the highest age-specific incidence in children
younger than 5 years of age. Paediatric sepsis resulted in 0.7% of all hospital encounters, with an
incidence of 2.8% in inpatients in the United States. - Epidemiologic studies using clinical data have found an incidence of paediatric sepsis in up to8% of all paediatric intensive care unit (PICU) admissions, contributing to 1 in 4 deaths in PICUs.
- Difficulties with breathing and oxygen requirement as a result of a pneumonia is the most common reason to cause sepsis, hence sepsis and pneumonia should always be considered together.
Risk factors for sepsis.
Most common sites and pathogens associated with sepsis – Tables 1 and 2, respectively
Table 2
Most common sites of infection and pathogens in sepsisª
Background and Definition
Background
The most common pathogens affecting previously healthy children were Staphylococcus aureus (9.4%), streptococcal species (7.9%), and Escherichia coli (7.1%), whereas the most common pathogens in children with chronic diseases were S. aureus (11%), Candida (9.8%), and Pseudomonas (8.1%). More than one-third of children with sepsis do not have an identifiable pathogen. This may be attributed to sepsis being caused by viral aetiologies or because of the limits in detection of bacterial pathogens, particularly if the volume inoculated into blood cultures is low or if the pathogens are fastidious or have specific growth requirements.
Definition of Sepsis
We refer to sepsis as sepsis-associated organ dysfunction and septic shock as sepsis with cardiovascular dysfunction (including hypotension, need for treatment with vasoactive agents, or impaired perfusion). Based on survey data, most paediatric clinicians used sepsis to refer to infection with life-threatening organ dysfunction, which differed from prior paediatric sepsis criteria that used systemic inflammatory response syndrome (SIRS) criteria, which have poor predictive properties, and included the redundant term, severe sepsis.
The Society of Critical Care Medicine (SCCM) task force recommends that sepsis in children be identified by a Phoenix Sepsis Score of at least 2 points in children with suspected infection, which indicates potentially life-threatening dysfunction of the respiratory, cardiovascular, coagulation, and/or neurological systems. Children with a Phoenix Sepsis Score of at least 2 points had in-hospital mortality of 7.1% in higher-resource settings and 28.5% in lower-resource settings, more than 8 times that of children with suspected infection not meeting these criteria.
Mortality was higher in children who had organ dysfunction in at least 1 of 4—respiratory, cardiovascular, coagulation, and/or neurological—organ systems that was not the primary site of infection. Septic shock was defined as children with sepsis who had cardiovascular dysfunction, indicated by at least 1 cardiovascular point in the Phoenix Sepsis Score, which included severe hypotension for age, blood lactate exceeding 5 mmol/L, or need for vasoactive medication. Children with septic shock had an in-hospital mortality rate of 10.8% and 33.5% in higher- and lower-resource settings, respectively.
Management
- If the decision is made to treat as sepsis, escalate and ensure senior medical staff/nursing team leaders are aware.
- Deliver the sepsis bundle consisting of:
- Intravenous access – If difficulties in obtaining intravenous (IV) access, don`t delay and insert an Intraosseous (IO) line.
- Obtain blood culture and lactate
- Intravenous antibiotics
- Initial fluid bolus (10 to 20 mL/kg crystalloids)
- Titrate fluids to perfusion, consider use of inotropes (peripheral or intraosseous as first line are acceptable).
- Reassess and escalate to PICU/retrieval services if no improvement.
Treatment tool: use the Paediatric Sepsis Pathway (as per CHQ guidelines)
Other useful resources and tools include
Clinical Guidelines and Tools for Sepsis
Recognition and Emergency Management in Children
Initial Resuscitation Algorithm for Children
Sepsis Pathway Form
Sepsis Flow Chart
Recognition and Emergency Management in children HQ Guideline
Disclaimer
This guideline is intended as a guide and provided for the PARIS on Country project during the course of the study period. The information has been prepared using a multidisciplinary approach with reference to the best information and evidence available at the time of preparation. This guideline is based of the Children’s Health Queensland Guideline which can be viewed below.
The guideline is not a substitute for clinical judgement, knowledge and expertise, or medical advice. Variation from the guideline, taking into account individual circumstances may be appropriate.
This guideline does not address all elements of standard practice and accepts that individual clinicians are responsible for:
- Providing care within the context of locally available resources, expertise, and scope of practice
- Supporting consumer rights and informed decision making in partnership with healthcare practitioners including the right to decline intervention or ongoing management
- Advising consumers of their choices in an environment that is culturally appropriate and which enables comfortable and confidential discussion. This includes the use of interpreter services where necessary
- Ensuring informed consent is obtained prior to delivering care
- Meeting all legislative requirements and professional standards
- Applying standard precautions, and additional precautions as necessary, when delivering care
- Documenting all care in accordance with mandatory and local requirements