Abstract PCCLB-27: CLINICAL MANAGEMENT AND OUTCOMES OF PEDIATRIC SEPSIS IN A PUBLIC REFERRAL HOSPITAL IN TANZANIA

Abstract

Aims & Objectives: In 2015, 2.6 million children died due to infections with the highest rates in sub-Saharan Africa (SSA). Sepsis is the final common pathway for most infectious deaths and initial management can greatly impact survival. We aimed to identify areas for improvement in the management of pediatric sepsis in Tanzania. Methods Prospective cohort study of children (28 days–14 years) with sepsis (by clinical systemic inflammatory response syndrome criteria) in the emergency medicine department (EMD) at Muhimbili National Hospital, Dar es Salaam. We performed univariate, bivariate and multivariable logistic regression analyses using StataMP 14.2. A p-value <0.05 was considered statistically significant and strength of association was determined by calculating odds ratios (OR) and 95% confidence intervals (CI). Results From July 1-September 30, 2016, 405 patients were enrolled with a median age of 25 months (IQR 11–63). The prevalence of diagnosed malaria, HIV and severe malnutrition was 9%, 2%, and 13%, respectively. In the EMD, patients received antibiotics 54% and a blood culture 1% of the time. EMD and in-hospital mortality were 1.5% (n=6) and 14% (n=57), respectively. Non-survivors were more likely than survivors to have received at least one fluid bolus (65% vs. 35%, p<0.0001), and bolus compared to no bolus was associated with an adjusted OR for mortality of 2.4 (95% CI 1.1–4.9). Conclusions We observed high in-hospital mortality and identified three areas for improvement in pediatric sepsis management: (1) antibiotic administration, (2) source identification, and (3) modification of the fluid resuscitation approach.