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Comparison between hospital- and community-acquired septic shock in children: a single-center retrospective cohort study 
 
Comparison between hospital- and community-acquired septic shock in children: a single-center retrospective cohort study
  Guo-Yun Su, Chao-Nan Fan, Bo-Liang Fang, Zheng-De Xie, Su-Yun Qian
 [Abstract] [Full Text] [PDF]   Pageviews: 860 Times
 
Background: We explored the differences in baseline characteristics, pathogens, complications, outcomes, and risk factors between children with hospital-acquired septic shock (HASS) and community-acquired septic shock (CASS) in the pediatric intensive care unit (PICU).
Methods: This retrospective study enrolled children with septic shock at the PICU of Beijing Children*s Hospital from January 1, 2016, to December 31, 2019. The patients were followed up until 28 days after shock or death and were divided into the HASS and CASS group. Logistic regression analysis was used to identify risk factors for mortality.
Results: A total of 298 children were enrolled. Among them, 65.9% ( n = 91) of HASS patients had hematologic/oncologic diseases, mainly with Gram-negative bacterial bloodstream infections (47.3%). Additionally, 67.7% (n = 207) of CASS patients had no obvious underlying disease, and most experienced Gram-positive bacterial infections (30.9%) of the respiratory or central nervous system. The 28-day mortality was 62.6% and 32.7% in the HASS and CASS groups, respectively (P < 0.001). Platelet [odds ratio (OR) = 0.996, 95% confidence interval (CI) = 0.992每1.000, P = 0.028], positive pathogen detection (OR = 3.557, 95% CI = 1.307每9.684, P = 0.013), and multiple organ dysfunction syndrome (OR = 10.953, 95% CI = 1.974每60.775, P = 0.006) were risk factors for 28-day mortality in HASS patients. Lactate (OR = 1.104, 95% CI = 1.022每1.192, P = 0.012) and mechanical ventilation (OR = 8.114, 95% CI = 1.806每36.465, P = 0.006) were risk factors for 28-day mortality in patients with CASS.
Conclusions: The underlying diseases, pathogens, complications, prognosis, and mortality rates varied widely between the HASS and CASS groups. The predictors of 28-day mortality were different between HASS and CASS pediatric patients with septic shock.
 
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World Journal of Pediatric Surgery

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