Microbiological and Clinical Characteristics of Pediatric Sepsis Patients with and without Septic Shock: A Retrospective Study at a Tertiary Pediatric Hospital in China

Abstract

Highlights: What are the main findings? Pediatric septic shock patients exhibited significantly higher mortality (17.4% vs. 4.7%, p < 0.001) and prolonged hospitalization (14.8 vs. 12.0 days, p = 0.003) compared to non-septic-shock sepsis patients. Elevated lactate (OR = 1.49, 95% CI = 1.29–1.75) and pulmonary infection (OR = 2.25, 95% CI = 1.35–3.73) were identified as independent risk factors for septic shock progression. What is the implication of the main finding? Early monitoring of lactate levels and pulmonary infection status could improve risk stratification for septic shock in pediatric sepsis, enabling timely interventions. Antibiotic stewardship optimization is critical, as combination antibiotic therapy was frequently used in viral (79%) and fungal (86.5%) sepsis despite limited efficacy, prolonging hospitalization in fungal cases (20.74 vs. 12.97 days, p = 0.017). Background: Pediatric sepsis, a life-threatening condition, often progresses to septic shock. However, microbiological and clinical profiles between pediatric sepsis patients with and without septic shock remain underexplored. Methods: This retrospective cohort study included 1200 pediatric sepsis patients (Phoenix Sepsis Score ≥ 2) from the Children’s Hospital of Chongqing Medical University between June 2018 and June 2023. Pediatric sepsis patients with septic shock were diagnosed based on the Phoenix Cardiovascular Score being ≥1. Clinical data and pathogens were taken from the electronic medical records and analyzed. Univariate and multivariable logistic regressions were conducted to identify the risk factors for septic shock. Results: Septic shock patients had longer hospital stays (14.8 vs. 12.0 days, p = 0.003) and higher mortality (17.4% vs. 4.7%, p < 0.001) when compared to non-septic-shock patients. Among these two groups, the pathogen prevalence revealed that bacterial pathogens dominated (48.9%), followed by viruses (10.3%). Acinetobacter baumannii, Escherichia coli, and Staphylococcus aureus remained the predominant pathogens; Pseudomonas aeruginosa and Mycoplasma pneumoniae were also increased. Combination antibiotic therapy was most frequent in patients with viral and fungal sepsis (79% and 86.5%, respectively). Patients with fungal sepsis had significantly longer hospital stays than those with viral sepsis (20.74 vs. 12.97 days, p = 0.017). Multivariable analysis identified that elevated lactate (OR = 1.49, 95% CI = 1.29–1.75) and pulmonary infection (OR = 2.25, 95% CI = 1.35–3.73) were independent risk factors for septic shock. Conclusions: Children with septic shock had higher mortality and prolonged hospitalization, with distinct microbiological profiles when compared with patients in the non-septic-shock group. Elevated lactate and presence of pulmonary infection are independent risk factors for septic shock. Early recognition of high-risk patients and tailored antimicrobial strategies are critical for improving outcomes.