Epidemiology of sepsis in pediatrics: first Colombian multicenter pilot survey

Introduction

In 2002, the Surviving Sepsis Campaign defined a strategy that aimed to reduce the high mortality due to sepsis. One point of this strategy was a recommendation to recognize that sepsis is a frequent cause of death and high economic costs in the pediatric intensive care unit. Knowledge of the disease is the first step to impact it. There are few studies on pediatric sepsis epidemiology in the world and none in Colombia.

Hypothesis

The epidemiological features of Colombian children are different from other countries.

Methods

We constructed a website where 14 intensive care units across the country reported in a prospective way the epidemiological features of children with sepsis using an electronic process [1]. We asked for sociodemographics, microbiological data, sepsis classification, complications, and outcome.

Results

We collected 253 patients from March to May 2009. Fifty-five percent of the cases were male and 45% were female; 53% were less than 1 year old. A total of 67.2% came from urban areas and 33% came from rural villages. Eighty-five percent were very poor (score 1 and 2 over 6 used in Colombia as socioeconomic classification). Forty-five percent have government-supported insurance. In total, 23.72% of the population presented with sepsis; 30.04% with severe sepsis; and 46.5% with septic shock. The infection origin was respiratory in 54.55%, followed by abdominal in 17.39%. In 50.2% no cause was identified. A total of 75.1% required mechanical ventilation. The mortality rate was 20.4%.

Conclusions

Sepsis, severe sepsis, or septic shock is a common diagnosis in Colombian intensive care units. The majority of pediatric patients are 2 years or younger and from the poorest communities. It affected males more. In the majority, the process starts in the respiratory system. We had difficulty identifying the cause. The disease causes high mortality and cost for a developing society. We need a complete survey to find a correct approach to the problem.