Risk factors for 28-day mortality and pathogen characteristics of septic shock in children: a 10-year retrospective cohort study.

BackgroundSeptic shock is a common cause of mortality in critical pediatric patients and pathogen distribution exhibits regional variation. Currently, there is a lack of data regarding septic shock from Southwest China. This study aimed to analyze mortality risk factors between community-acquired septic shock (CASS) and hospital-acquired septic shock (HASS), and changes in pathogen distribution before and after COVID-19 pandemic.MethodsThis retrospective study was conducted at a tertiary pediatric hospital between January 2015 and December 2024 involving children in septic shock. The clinical characteristics, laboratory parameters, pathogen characteristics, and follow-up findings were collected. The patients were divided into CASS and HASS groups. Binary logistic regression analysis was used to identify risk factors for mortality.ResultsA total of 850 patients were included with an average age of 13.0 months (3.7,77.8 months). The 28-d mortality rate was 27.4% and 38.1% in the CASS and HASS groups, respectively. The common infection sites were the respiratory tract (51.2%), digestive tract (27.7%), and central nervous system (7.4%). Multiple organ dysfunction syndrome (MODS) was diagnosed in 68.4% of the patients. The risk factors for mortality in the entire cohort were underlying diseases, lower pediatric critical illness score, bloodstream infection, invasive mechanical ventilation, MODS, renal injury, no vitamin C use, an low platelet count, and an elevated lactate concentration based on multivariate analysis, which were nearly consistent with the CASS group. The pediatric critical illness score and MODS were risk factors in the HASS group. The positive rate of pathogens and blood cultures were 54.1% and 12.6%, respectively. The detection rates for Escherichia coli and Enterococcus in the post-COVID era showed a downward trend compared to the pre-COVID era, while Streptococcus pneumoniae, Klebsiella pneumoniae, and Acinetobacter baumannii showed an upward trend. In addition, extended-spectrum β-lactamase-producing E. coli and methicillin-resistant Staphylococcus aureus also increased. Of the HASS patients, 65.1% had hematologic/oncologic diseases, mainly with Gram-negative bacterial infections.ConclusionThe underlying diseases, pathogens, complications, prognosis, and predictors of mortality varied widely between the CASS and HASS groups.