Incidence of and mortality due to sepsis, severe sepsis and septic shock in Italian Pediatric Intensive Care Units: a prospective national survey.

OBJECTIVES: The objective was to assess the incidence of sepsis, severe sepsis and septic shock and their mortality in Italian Pediatric Intensive Care Units (PICUs).

DESIGN: This is a prospective, observational, multi-center, 1-year study.

SETTING: Fifteen medical-surgical PICUs participated in this study.

PATIENTS: Two-thousand and seven hundred and forty-one children (2,741), aged 0-16 years, who were consecutively admitted in the participating PICUs, from 1 March 2004 to 28 February 2005, were enrolled in the study.

INTERVENTIONS: There were no interventions in this study.

MEASUREMENTS AND MAIN RESULTS: Data on infection, systemic inflammatory response syndrome (SIRS), severe sepsis and septic shock were collected using criteria defined by Proulx in 1996. Sepsis-related diagnosis was stratified for five age groups (neonates, infant, preschool, school, adolescent) and type of admission (medical, surgical, trauma). The presence of existing comorbidities has been considered for children with and without sepsis diagnosis. The results showed a lower overall incidence of sepsis, severe sepsis and septic shock (7.9, 1.6 and 2.1%, respectively) if compared with other studies. Children with sepsis diagnosis had a higher morbidity and higher mortality than those without sepsis. Severe sepsis and septic shock had a mortality rate of 17.7 and 50.8%, respectively. Mortality is significantly higher for children with existing comorbidities than those without existing comorbidities.

CONCLUSIONS: Septic shock mortality is still high in Italian PICUs and attempts to improve medical treatment are necessary. We suggest that application of the new definitions for sepsis diagnosis and diffusion of guidelines for early recognition and aggressive treatment of severe sepsis and septic shock in Italy represent a high priority to reduce mortality.

DESCRIPTOR: The descriptor is pediatrics.