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Bacterial and Fungal Etiology of Sepsis in Children in the United States

Reconsidering Empiric Therapy

Prout, Andrew J. MD1–3; Talisa, Victor B. BA1,4; Carcillo, Joseph A. MD2; Decker, Brooke K. MD5; Yende, Sachin MD1,2,6

doi: 10.1097/CCM.0000000000004140
Online Clinical Investigation: PDF Only

Objectives: Timely empiric antimicrobial therapy is associated with improved outcomes in pediatric sepsis, but minimal data exist to guide empiric therapy. We sought to describe the prevalence of four pathogens that are not part of routine empiric coverage (e.g., Staphylococcus aureus, Pseudomonas aeruginosa, Clostridium difficile, and fungal infections) in pediatric sepsis patients in a contemporary nationally representative sample.

Design: This was a retrospective cohort study using administrative data.

Setting: We used the Nationwide Readmissions Database from 2014, which is a nationally representative dataset that contains data from nearly half of all discharges from nonfederal hospitals in the United States.

Patients: Discharges of patients who were less than 19 years old at discharge and were not neonatal with a discharge diagnosis of sepsis.

Interventions: None.

Measurements and Main Results: Of the 19,113 pediatric admissions with sepsis (6,300 [33%] previously healthy and 12,813 [67%] with a chronic disease), 31% received mechanical ventilation, 19% had shock, and 588 (3.1%) died during their hospitalization. Among all admissions, 8,204 (42.9%) had a bacterial or fungal pathogen identified. S. aureus was the most common pathogen identified in previously healthy patients (n = 593, 9.4%) and those with any chronic disease (n = 1,430, 11.1%). Methicillin-resistant S. aureus, P. aeruginosa, C. difficile, and fungal infections all had high prevalence in specific chronic diseases associated with frequent contact with the healthcare system, early surgery, indwelling devices, or immunosuppression.

Conclusions: In this nationally representative administrative database, the most common identified pathogen was S. aureus in previously healthy and chronically ill children. In addition, a high proportion of children with sepsis and select chronic diseases had infections with methicillin-resistant S. aureus, fungal infections, Pseudomonas infections, and C. difficile. Clinicians caring for pediatric patients should consider coverage of these organisms when administering empiric antimicrobials for sepsis.

1The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.

2Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.

3Department of Pediatrics, Division of Critical Care, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY.

4Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.

5Division of Infectious Diseases Department of Medicine, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA.

6Division of Critical Care, Department of Medicine, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA.

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Drs. Prout’s (T32HL007820) and Yende’s institutions received funding from National Heart, Lung and Blood Institute of the National Institutes of Health (NIH). Drs. Prout, Carcillo, and Yende received support for article research from the NIH. Dr. Carcillo’s institution received funding from the National Institute of Child Health and Human Development and National Institute of General Medical Sciences. Dr. Decker disclosed government work. Dr. Talisa disclosed that she does not have any potential conflicts of interest.

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