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Sepsis

Sepsis is a topic covered in the 5-Minute Pediatric Consult.

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Basics

Description

  • Systemic inflammatory response syndrome (SIRS): nonspecific inflammatory response, defined as at least two of the following four criteria (one of which must be either abnormal temperature OR leukocyte count):
    • Temperature >38.5 or <36°C
    • Tachycardia (mean HR >2 SDs above normal for age)
    • Tachypnea (mean RR >2 SDs above normal for age), or requiring mechanical ventilation for acute respiratory failure
    • Leukocytosis, leukopenia, or >10% bands
  • Sepsis: SIRS in the presence of infection
    • Infection: suspected or proven infection or clinical syndrome associated with high probability of infection
  • Severe sepsis: sepsis accompanied by evidence of altered end organ perfusion (cardiovascular dysfunction OR acute respiratory distress syndrome [ARDS] OR two or more other organ dysfunctions)
  • Septic shock: sepsis with cardiovascular dysfunction (hypotension, need for vasoactive drug to maintain normal BP, or any combination of altered mental status, unexplained metabolic acidosis, increased arterial lactate, oliguria, prolonged capillary refill, and core-to-peripheral temperature gap)

Epidemiology

Incidence

Estimated overall annual incidence of 0.9 cases per 1,000 children but varies by age

  • Newborn infants: 9.7 per 1,000 children
  • Non–newborn infants: 2.3 per 1,000 children
  • Age 1 to 4 years: 0.5 per 1,000 children
  • Age 5 to 14 years: 0.2 per 1,000 children
  • Age 15 to 19 years: 0.5 per 1,000 children

Prevalence

Sepsis is among the most common (10–25%) medical diagnoses on admission to pediatric intensive care units (PICUs).

Risk Factors

Sepsis may occur in previously healthy children, but children with chronic underlying conditions that render them immunosuppressed or vulnerable to invasive infections are at increased risk, including:

  • Neutropenia (neutrophils <1,000/mm3, especially <500/mm3)
  • Primary or acquired immunodeficiency (e.g., AIDS, severe combined immunodeficiency)
  • Malignancy
  • Organ transplant recipients
  • Chronic use of high-dose systemic steroids
  • Indwelling central venous catheters or other invasive devices (e.g., urinary catheter)
  • Hyposplenism, either surgical or functional (e.g., sickle cell anemia)
  • Neuromuscular disease (e.g., static encephalopathy)
  • Extensive burns
  • Multiple trauma injuries
  • Prematurity
  • Unimmunized/underimmunized children
  • Severe malnutrition

General Prevention

  • Routine vaccination for Haemophilus influenzae type b (Hib), Streptococcus pneumoniae, and Neisseria meningitidis particularly in high-risk patients (e.g., asplenia)
  • Antibiotic prophylaxis for household or day care exposure to confirmed cases of Hib or N. meningitidis
  • Antibiotic prophylaxis for children with asplenia
  • Prompt evaluation of fever in immunosuppressed patients
  • Aseptic technique for insertion and care of vascular catheters, minimizing duration of use

Etiology

  • Microbial invasion of the bloodstream or release of microbial products/toxins into the bloodstream; stimulates host defense, resulting in activation of proinflammatory mediators and systemic inflammation
  • Pathogens vary with age, host immune status, and setting (community or hospital).
  • Neonates
    • Group B Streptococcus
    • Escherichia coli
    • Staphylococcus aureus
    • Listeria monocytogenes
    • Enterococcus spp.
    • Herpes simplex virus
    • Enterovirus
  • In neonates with a history of hospitalization, instrumentation, or mechanical ventilation, also consider
    • Coagulase-negative staphylococci
    • Gram-negative bacilli
    • Candida spp.
  • Otherwise healthy older infants and children
    • S. pneumoniae
    • N. meningitidis
    • S. aureus
    • Group A Streptococcus
    • Salmonella spp.
    • Rickettsiae
    • Influenza
  • Patients with underlying immune defects are also susceptible to a broad range of additional organisms.

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Citation

Cabana, Michael D., editor. "Sepsis." 5-Minute Pediatric Consult, 8th ed., Wolters Kluwer, 2019. Pediatrics Central, peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617260/all/Sepsis.
Sepsis. In: Cabana MD, ed. 5-Minute Pediatric Consult. 8th ed. Wolters Kluwer; 2019. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617260/all/Sepsis. Accessed April 19, 2019.
Sepsis. (2019). In Cabana, M. D. (Ed.), 5-Minute Pediatric Consult. Available from https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617260/all/Sepsis
Sepsis [Internet]. In: Cabana MD, editors. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. [cited 2019 April 19]. Available from: https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617260/all/Sepsis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Sepsis ID - 617260 ED - Cabana,Michael D, BT - 5-Minute Pediatric Consult UR - https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617260/all/Sepsis PB - Wolters Kluwer ET - 8 DB - Pediatrics Central DP - Unbound Medicine ER -