1242: PEDIATRIC SEPSIS HAS HIGH MORTALITY REGARDLESS OF PATHOGEN IDENTIFICATION

Abstract

Introduction: Sepsis remains a major cause of morbidity and mortality in critically ill children worldwide. Culture-negative sepsis (CNS) is diagnosed when a patient meets the criteria for sepsis with no causative pathogen identified. The etiology of CNS may be an uncultivable pathogen, treatment with antimicrobials before a culture was drawn, or a non-infectious cause. For adults, CNS is estimated to comprise up to 50% of all ICU admissions for sepsis, but the characteristics of the pediatric population with CNS are poorly understood. Methods: This is a retrospective cohort study of 3 pediatric ICUs within an urban, tertiary children’s hospital. All patients who received piperacillin-tazobactam, the institution’s standard initial broad-spectrum agent, were screened for study inclusion. Patients ≤18 years old who were hospitalized between March 2020 and February 2021 and met the criteria for sepsis defined in the 2020 Pediatric Surviving Sepsis Guidelines were included in the study. Results: Of the 302 patients screened, 61 met the criteria for sepsis. Thirty-two patients (52.5%) had culture-positive sepsis (CPS) and 29 patients (47.5%) had CNS. The median age for CPS was 5 years (interquartile range [IQR] 1-15y) and 3 years (IQR 0.5-15y) for CNS. Both groups had similar numbers of medically complex patients with >3 comorbidities (68.8% for CPS vs 70% for CNS, p=0.98). There was no statistically significant difference in mortality (28.1% CPS vs 17.2% CNS, p=0.32), need for mechanical ventilation (62.5% vs 58.6%, p=0.19), need for vasoactive medication (62.5% vs 55.2%, p=0.41), or median ICU and hospital length of stay (47 vs 27d, p=0.11; 53 vs. 27d, p=0.07) between groups. CPS patients were treated with longer courses of antibiotics (median 10 vs 7d for CNS p=0.03). Conclusions: When compared to CPS, outcomes for patients with CNS were similar though overall rates of mortality in both groups were high compared to previous reports (4-15%). Patients with CNS comprised a considerable proportion of the total number of patients with sepsis. A median ICU length of stay of 27 days for CNS patients represents significant resource utilization for these individual children. Given these findings, further studies are warranted to better understand this population and determine optimal treatment strategies.