Abstract
Objective: To investigate the association between antibiotics administration timing with morbidity and mortality in children with severe sepsis and septic shock, presenting to a tertiary care center in a developing country.Methods: This is a retrospective study of children aged 14 years or younger diagnosed with severe sepsis or septic shock at a free-standing tertiary children's hospital in Saudi Arabia between April 2015 and February 2018. We investigated the association between antibiotic administration timing and pediatric intensive care unit (PICU) mortality, PICU length of stay (LOS), hospital LOS, and ventilation-free days after adjusting for confounders.Results: Among the 189 admissions, 77 patients were admitted with septic shock and 112 with severe sepsis. Overall, the mortality rate was 16.9%. The overall median time from sepsis recognition to antibiotic administration was 105 min (IQR: 65–185.5 min); for septic shock patients, it was 85 min (IQR: 55–148 min), and for severe sepsis, 130 min (IQR: 75.5–199 min). Delayed antibiotic administration (> 3 h) was associated with 3.85 times higher PICU mortality (95% confidence intervals 1.032–14.374) in children with septic shock than in children who receive antibiotics within 3 h, after controlling for severity of illness, age, comorbidities, and volume resuscitation. However, delayed antibiotics administration was not significantly associated with higher PICU mortality in children diagnosed with severe sepsis.Conclusions: Delayed antibiotics administration in children with septic shock admitted to a free-standing children's hospital in a developing country was associated with PICU mortality.
Highlights
IntroductionMortality rates because of severe sepsis and septic shock range from 10 to 50% [2,3,4]
Sepsis is the most common cause of death in children [1]
We investigated the association between antibiotic administration timing and pediatric intensive care unit (PICU) mortality, PICU length of stay (LOS), hospital LOS, and ventilation-free days after adjusting for confounders
Summary
Mortality rates because of severe sepsis and septic shock range from 10 to 50% [2,3,4]. The prevalence of sepsis and septic shock continues to rise [5, 6]. The increasing prevalence of sepsis, which is associated with poor outcomes, has led to the development of practice guidelines by several organizations. The clinical guidelines comprised rapid identification of sepsis, management with fluid resuscitation and antibiotic administration in the first hour, and intensive care hemodynamic support with source control [7]. These guidelines were revised in 2007 and 2014 [8, 9]. The Surviving Sepsis Campaign (SSC) published the first pediatric guidelines in 2020 [10]
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