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
- 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.
- 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).
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design and Patients
2.2. Microbiological Analysis
2.3. Statistical Analysis
3. Results
3.1. Study Population
3.2. Comparison of Baseline Characteristics in Patients with and without Septic Shock
3.3. Epidemiological Trends of Pathogens in Pediatric Sepsis
3.4. Prevalent Pathogens Between Children with and without Septic Shock
3.5. Prevalent Pathogens in Non-Survivors with and without Septic Shock
3.6. Antibiotic Utilization in Viral and Fungal Infection Between Patients in the Septic Shock and Non-Septic-Shock Groups
3.7. Univariate and Multivariate Analysis of Risk Factors Associated with Septic Shock
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
OR | Odds ratio |
CI | Confidence interval |
A. baumannii | Acinetobacter baumannii |
E. coli | Escherichia coli |
S. aureus | Staphylococcus aureus |
S. pneumoniae | Streptococcus pneumoniae |
P. aeruginosa | Pseudomonas aeruginosa |
M. pneumoniae | Mycoplasma pneumoniae |
K. pneumoniae | Klebsiella pneumoniae |
H. influenzae | Haemophilus influenzae |
NLR | Neutrophil-to-lymphocyte ratio |
RSV | Respiratory syncytial virus |
PLT | Platelet count |
PLT/MPV | Platelet-to-mean platelet volume ratio |
RDW | Red cell distribution width |
L/A | Lactate-to-albumin ratio |
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Characteristics | Enrolled Children with Sepsis | Septic Shock Group (n = 757) | Non-Septic-Shock Group (n = 443) | Z/(X2) | p Value | |
---|---|---|---|---|---|---|
Gender (n,%) | (1.972) | 0.160 | ||||
Male | 670(55.8%) | 411(54.3%) | 259(58.5%) | |||
Female | 530(44.2%) | 346(45.7%) | 184(41.5%) | |||
Age (n,%) | (18.792) | 0.002 | ||||
<1 month | 146(12.2%) | 113(14.9%) | 33(7.4%) | (14.624) | <0.001 | |
1–11 months | 305(25.4%) | 182(24.0%) | 123(27.8%) | |||
1–2 years | 152(12.7%) | 90(11.9%) | 62(14.0%) | |||
2–5 years | 244(20.3%) | 147(19.4%) | 97(21.9%) | |||
5–12 years | 255(21.2%) | 169(22.4%) | 86(19.4%) | |||
12–18 years | 98(8.2%) | 56(7.4%) | 42(9.5%) | |||
Site of pathogen detection (n,%) | (39.685) | <0.001 | ||||
Lower respiratory tract | 371(47.3%) | 278(52.2%) | 93(36.9%) | (15.971) | <0.001 | |
Blood | 204(26.0%) | 141(26.5%) | 63(25.0%) | (0.188) | 0.665 | |
Skin/wound discharge | 104(13.2%) | 53(9.9%) | 51(20.2%) | (15.777) | <0.001 | |
Catheter | 37(4.7%) | 27(5.1%) | 10(4.0%) | (0.459) | 0.498 | |
Pleural/abdominal effusion | 22(2.8%) | 14(2.6%) | 8(3.2%) | (0.189) | 0.664 | |
Cerebrospinal fluid | 10(1.3%) | 2(0.4%) | 8(3.2%) | (10.661) | 0.001 | |
Other | 37(4.7%) | 18(3.3%) | 19(7.5%) | (6.601) | 0.010 | |
Types of bacterial detection | (9.578) | 0.023 | ||||
No bacteria detection | 613(51.1%) | 362(47.8%) | 251(56.7%) | (8.737) | 0.003 | |
Single bacterial detection positive | 442(36.8%) | 294(38.8%) | 148(33.4%) | (3.540) | 0.060 | |
Dual bacterial detection positive | 100(8.3%) | 68(9.0%) | 32(7.2%) | (1.132) | 0.287 | |
Polybacterial detection positive | 45(3.8%) | 33(4.4%) | 12(2.7%) | (2.109) | 0.146 | |
Types of viral detection | (2.250) | 0.522 | ||||
No virus detected | 1076(89.7%) | 683(90.2%) | 393(88.7%) | (0.689) | 0.407 | |
Single viral detection positive | 111(9.2%) | 67(8.9%) | 44(10.0%) | (0.389) | 0.533 | |
Dual viral detection positive | 12(1.0%) | 7(0.9%) | 5(1.1%) | (0.117) | 0.732 | |
Polyviral detection positive | 1(0.1%) | 0 | 1(0.2%) | (1.710) | 0.191 | |
Types of fungal detection | (1.521) | 0.217 | ||||
No fungus detected | 1133(94.4%) | 710(93.8%) | 423(95.5%) | |||
Fungal detection positive | 67(5.6%) | 47(6.2%) | 20(4.5%) | |||
Types of pathogen co-detection | (5.600) | 0.133 | ||||
Bacterial plus viral detection positive | 20(40.0%) | 16(47.1%) | 4(25.0%) | (2.206) | 0.137 | |
Bacterial plus fungal detection positive | 26(52.0%) | 14(41.2%) | 12(75.0%) | (4.987) | 0.026 | |
Viral plus fungal detection positive | 1(2.0%) | 1(2.9%) | 0 | (0.480) | 0.488 | |
Multi-pathogen detection positive | 3(6.0%) | 3(8.8%) | 0 | (1.502) | 0.220 | |
Pulmonary infection (n,%) | (85.243) | <0.001 | ||||
Yes | 815(67.9%) | 586(77.4%) | 229(51.7%) | |||
No | 189(15.8%) | 87(11.5%) | 102(23.0%) | |||
Unknown | 196(16.3%) | 84(11.1%) | 112(25.3%) | |||
Ventilator support (n,%) | (68.149) | <0.001 | ||||
Yes | 507(42.3%) | 388(51.3%) | 119(26.9%) | |||
No | 693(57.7%) | 369(48.7%) | 324(73.1%) | |||
WBC[×109/L,M(P25,P75)] | 11.88(6.64,18.02) | 11.8(6.68,17.82) | 12.22(6.46,18.24) | –0.010 | 0.992 | |
PLT[×109/L,M(P25,P75)] | 226(108.5,371) | 254(143,392.5) | 163(68.75,311.25) | 7.066 | <0.001 | |
PLT/MPV[×109/(L×fL),M(P25,P75)] | 25.09(14.17,38.72) | 26.57(16.05,40.02) | 22.79(9.34,34.93) | 4.053 | <0.001 | |
NLR/M(P25,P75) | 2.81(1.36,6.16) | 2.59(1.35,5.45) | 3.38(1.39,7.56) | –2.839 | 0.005 | |
PDW/M(P25,P75) | 12.1(10.5,14.6) | 12(10.5,14.4) | 12.2(10.6,15.1) | –1.213 | 0.225 | |
RDW/M(P25,P75) | 14.9(13.5,19.8) | 15.1(13.6,26.5) | 14.5(13.4,17.38) | 3.186 | 0.001 | |
PT/M(P25,P75) | 1.17(1.06,1.43) | 1.16(1.04,1.38) | 1.33(1.12,1.47) | –6.041 | <0.001 | |
D-dimer/M(P25,P75) | 4.03(2.17,9.70) | 3.61(1.82,9.21) | 4.78(2.62,11.08) | –4.963 | <0.001 | |
Lactic Acid/[mmol/L,M(P25,P75)] | 1.8(1.1,3.58) | 2(1.2,4.4) | 1.41(0.9,2.4) | 6.797 | <0.001 | |
In-hospital stay/[d,M(P25,P75)] | 13.65(7.59,23.76) | 14.8(7.6,27.3) | 12.0(7.6,19.4) | 2.982 | 0.003 | |
In-hospital mortality (n,%) | –40.498 | <0.001 | ||||
Yes | 153(12.8%) | 132(17.4%) | 21(4.7%) | |||
No | 1047(87.2%) | 625(82.6%) | 422(95.3%) |
Characteristics | Bacterial Sepsis Patients (n = 552) | Viral Sepsis Patients (n = 100) | Fungal Sepsis Patients (n = 37) | p Value |
---|---|---|---|---|
Types of antibiotic medication (n,%) | 0.321 | |||
Monotherapy | 38(6.8%) | 21(21%) | 5(13.5%) | |
Combination therapy | 514(93.2%) | 79(79%) | 32(86.5%) | |
Antibiotic medication regimen (n,%) | 0.023 | |||
β-lactam antibiotics | 265(48%) | 67(67%) | 16(43.2%) | |
β-lactam antibiotics plus macrolide antibiotics | 47(8.5%) | 4(4%) | 3(8.1%) | |
β-lactam antibiotics plus quinolone antibiotics | 41(7.4%) | 1(1%) | 1(2.7%) | |
β-lactam antibiotics plus vancomycin | 152(27.5%) | 20(20%) | 7(18.9%) | |
β-lactam antibiotics plus macrolide antibiotics plus other antibiotics | 1(0.2%) | 1(1%) | 4(10.8%) | |
β-lactam antibiotics plus vancomycin plus other antibiotics | 46(8.4%) | 6(6%) | 6(16.3%) | |
Only vancomycin | 0 | 1(1%) | 0 | |
Ventilator support (n,%) | 0.341 | |||
Yes | 274(49.6%) | 37(37%) | 17(45.9%) | |
No | 278(50.4%) | 63(63%) | 20(54.1%) | |
In-hospital stay/[d,M(P25,P75)] | 16.07(9.40,29.94) | 12.97(6.38,19.52) | 20.74(11.37,29.46) | 0.017 |
In-hospital mortality (n,%) | 0.235 | |||
Yes | 64(11.6%) | 16(16%) | 3(8.1%) | |
No | 488(88.4%) | 84(84%) | 34(91.9%) |
Variables | Univariate | Multivariate | ||||
---|---|---|---|---|---|---|
OR | 95%CI | p Value | OR | 95%CI | p Value | |
Bacterial detection positive | 1.426 | 1.127–1.807 | 0.003 | 1.152 | 0.771–1.724 | 0.489 |
Viral detection positive | 0.852 | 0.584–1.250 | 0.407 | |||
Fungal detection positive | 1.400 | 0.830–2.445 | 0.219 | |||
Age (<1month, ≥1month) | 2.180 | 1.467–3.321 | <0.001 | 2.062 | 1.001–4.498 | 0.058 |
PLT | 1.002 | 1.001–1.003 | <0.001 | 0.999 | 0.992–1.006 | 0.824 |
PLT/MPV | 1.015 | 1.007–1.023 | <0.001 | 1.019 | 0.953–1.089 | 0.588 |
PT | 0.936 | 0.802–1.095 | 0.399 | |||
D-dimer | 0.998 | 0.989–1.007 | 0.594 | |||
NLR | 0.984 | 0.968–1.001 | 0.062 | |||
RDW | 1.016 | 1.007–1.026 | <0.001 | 1.01 | 0.993–1.029 | 0.249 |
Lactic acid | 1.408 | 1.286–1.557 | <0.001 | 1.487 | 1.294–1.751 | <0.001 |
Pulmonary infection | 3.000 | 2.171–4.156 | <0.001 | 2.246 | 1.351–3.734 | 0.002 |
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Peng, K.-C.; Li, Q.-Y.; Chen, L.; Zhao, Y.; Liu, H.; Kong, Z.-X.; Luo, Z.-X. Microbiological and Clinical Characteristics of Pediatric Sepsis Patients with and without Septic Shock: A Retrospective Study at a Tertiary Pediatric Hospital in China. Children 2025, 12, 1146. https://doi.org/10.3390/children12091146
Peng K-C, Li Q-Y, Chen L, Zhao Y, Liu H, Kong Z-X, Luo Z-X. Microbiological and Clinical Characteristics of Pediatric Sepsis Patients with and without Septic Shock: A Retrospective Study at a Tertiary Pediatric Hospital in China. Children. 2025; 12(9):1146. https://doi.org/10.3390/children12091146
Chicago/Turabian StylePeng, Kai-Cheng, Qin-Yuan Li, Lin Chen, Yan Zhao, Hui Liu, Zhen-Xuan Kong, and Zheng-Xiu Luo. 2025. "Microbiological and Clinical Characteristics of Pediatric Sepsis Patients with and without Septic Shock: A Retrospective Study at a Tertiary Pediatric Hospital in China" Children 12, no. 9: 1146. https://doi.org/10.3390/children12091146
APA StylePeng, K.-C., Li, Q.-Y., Chen, L., Zhao, Y., Liu, H., Kong, Z.-X., & Luo, Z.-X. (2025). Microbiological and Clinical Characteristics of Pediatric Sepsis Patients with and without Septic Shock: A Retrospective Study at a Tertiary Pediatric Hospital in China. Children, 12(9), 1146. https://doi.org/10.3390/children12091146