Indian J Pediatr DOI 10.1007/s12098-014-1618-x
ORIGINAL ARTICLE
Clinical Epidemiology of SIRS and Sepsis in Newly Admitted Children Sheetal Ganjoo & Kaisar Ahmad & Umar Amin Qureshi & Zahed Hussain Mir
Received: 19 March 2014 / Accepted: 21 October 2014 # Dr. K C Chaudhuri Foundation 2014
Abstract Objective To assess the clinical and demographic profile of Systemic Inflammatory Response Syndrome (SIRS) and sepsis, among newly admitted children in different age groups in a hospital in North India. Methods This prospective study was conducted at a referral care centre in Northern India. All children, age group 0 to 10 % immature neutrophils. Tachycardia, defined as a mean heart rate >2 SD above normal for age or otherwise unexplained persistent elevation over a 0.5 to 4 h time period OR for children 3 °C
2. Respiratory: PaO2/FiO2 65 torr or 20 mmHg over baseline OR requirement of >50 % FiO2 to maintain saturation ≥92 % OR Need for non elective invasive or noninvasive mechanical ventilation. 3. Neurologic: GCS ≤11 OR Acute change in mental status with a decrease in GCS ≥3 points from baseline. 4. Hematologic: Platelet count 2. 5. Renal: Serum creatinine ≥2 times upper limit normal for age or two fold increase in baseline creatinine. 6. Hepatic: Total bilirubin ≥4 mg/dL (not for newborns) OR alanine transaminase (ALT) 2 times upper limit of normal for age.
Indian J Pediatr No SIRS (n=159)
Fig. 1 Study design and results 20 time periods,
Abnormal temperature
24 h long,
(n=345)
Sepsis (n=129)
Infective SIRS (n=159) Septic shock (n=19)
randomly chosen
SIRS (n=186)
Total SIRS (n=201)
Children treated (n=865)
Severe Sepsis (n=30)
SIRS abnormal TLC (n=15)
Normal temperature (n=520)
Noninfective SIRS (n=42)
Other organ dysfunction (n=11)
No SIRS (n=505)
During the study period a total of 865 patients were screened for SIRS criteria. Five hundred and thirty were male and 335 were female. System wise break up of admission diagnosis of these 865 patients was GIT 249, respiratory 286, CNS 163, hematological 50, CVS 44, renal 14, nutritional 18, genetic 10, and metabolic 31. Protein Energy Malnutrition was seen in 98 (IAP PEM grade I- 31, grade II- 30, grade III- 22, grade IV- 15). Two hundred and one patients fulfilled the SIRS criteria, thus the prevalence of SIRS amongst hospitalised children was 23 %. Seventy nine percent (n=159) of patients had infection associated SIRS and 21 % (42) had non infective SIRS. Sixty four percent (n=129) SIRS patients had uncomplicated sepsis; Organ dysfunction in SIRS was noted in 25 % (n=51); 15 % (n=30) patients fulfilled criteria for severe sepsis and out of these 30 patients, 19 had septic shock;
prevalence of septic shock among SIRS was therefore 9.45 %. Figure 1 shows design of the study and results. The diagnosis of SIRS in the index study was mostly based on a combination of abnormal temperature with respiratory rate >2SD above normal for age (85 %, n=172). A combination of abnormal temperature with leucocyte counts (37 %, n=74) and abnormal leucocyte counts with respiratory rate >2 SD above normal for age (38 %, n=76) also defined SIRS. Seventy four patients (37 %) fulfilled more than 2 SIRS criteria. Majority (46 %, n=94) of patients were in the age group of 1 to 6 y (Table 1). Acute exacerbation of bronchial asthma constituted the major chunk of noninfective SIRS (Table 2). 23.4 % of males and 22.9 % of females had SIRS. The gender distribution of patients in SIRS and No SIRS group was not significant (p 0.45). Similarly there was no gender difference among patients with sepsis (males: 18.8 %, females: 17.6 %, p >0.5). Sepsis was confirmed by isolation of microbial agent in 18 % (n=29). This included 19 positive blood culture, 5 positive urine cultures, one sputum positive acid fast bacilli (AFB), one positive PCR for mycobacterial TB in pleural fluid, one sputum positive for Klebsiella in necrotising pneumonia, two with positive blood as well as urine culture. The most common organism isolated was Staphylococcus aureus (n=9) followed by gram negative organisms (Klebsiella, E. coli, Enterococcus, non lactose fermenting E. coli (NLF), Citrobacter in that order). Focus of infection in majority was pulmonary (44 %) followed by abdomen and CNS (17.6 % each). Intravascular focus constituted 14.4 %.
Table 1 Age wise distribution of SIRS patients
Table 2 Etiology of non infective SIRS
Patient data was analysed using descriptive statistics. The prevalence of SIRS among hospitalised children was detected with 95 % CI. Comparison of means (duration of hospital stay, duration of antibiotic therapy) was done by using unpaired t- test. Comparison of proportions (mortality analysis among SIRS and non SIRS patients, gender distribution of SIRS/Sepsis) was done by using chi square test. The study data was analysed using Statistical Package for Social Sciences (SPSS).
Results
Age group
Number
Percentage
0 days to 1 wk 1 wk to 1 mo 1 mo to 1 y > 1 y to
ORIGINAL ARTICLE
Clinical Epidemiology of SIRS and Sepsis in Newly Admitted Children Sheetal Ganjoo & Kaisar Ahmad & Umar Amin Qureshi & Zahed Hussain Mir
Received: 19 March 2014 / Accepted: 21 October 2014 # Dr. K C Chaudhuri Foundation 2014
Abstract Objective To assess the clinical and demographic profile of Systemic Inflammatory Response Syndrome (SIRS) and sepsis, among newly admitted children in different age groups in a hospital in North India. Methods This prospective study was conducted at a referral care centre in Northern India. All children, age group 0 to 10 % immature neutrophils. Tachycardia, defined as a mean heart rate >2 SD above normal for age or otherwise unexplained persistent elevation over a 0.5 to 4 h time period OR for children 3 °C
2. Respiratory: PaO2/FiO2 65 torr or 20 mmHg over baseline OR requirement of >50 % FiO2 to maintain saturation ≥92 % OR Need for non elective invasive or noninvasive mechanical ventilation. 3. Neurologic: GCS ≤11 OR Acute change in mental status with a decrease in GCS ≥3 points from baseline. 4. Hematologic: Platelet count 2. 5. Renal: Serum creatinine ≥2 times upper limit normal for age or two fold increase in baseline creatinine. 6. Hepatic: Total bilirubin ≥4 mg/dL (not for newborns) OR alanine transaminase (ALT) 2 times upper limit of normal for age.
Indian J Pediatr No SIRS (n=159)
Fig. 1 Study design and results 20 time periods,
Abnormal temperature
24 h long,
(n=345)
Sepsis (n=129)
Infective SIRS (n=159) Septic shock (n=19)
randomly chosen
SIRS (n=186)
Total SIRS (n=201)
Children treated (n=865)
Severe Sepsis (n=30)
SIRS abnormal TLC (n=15)
Normal temperature (n=520)
Noninfective SIRS (n=42)
Other organ dysfunction (n=11)
No SIRS (n=505)
During the study period a total of 865 patients were screened for SIRS criteria. Five hundred and thirty were male and 335 were female. System wise break up of admission diagnosis of these 865 patients was GIT 249, respiratory 286, CNS 163, hematological 50, CVS 44, renal 14, nutritional 18, genetic 10, and metabolic 31. Protein Energy Malnutrition was seen in 98 (IAP PEM grade I- 31, grade II- 30, grade III- 22, grade IV- 15). Two hundred and one patients fulfilled the SIRS criteria, thus the prevalence of SIRS amongst hospitalised children was 23 %. Seventy nine percent (n=159) of patients had infection associated SIRS and 21 % (42) had non infective SIRS. Sixty four percent (n=129) SIRS patients had uncomplicated sepsis; Organ dysfunction in SIRS was noted in 25 % (n=51); 15 % (n=30) patients fulfilled criteria for severe sepsis and out of these 30 patients, 19 had septic shock;
prevalence of septic shock among SIRS was therefore 9.45 %. Figure 1 shows design of the study and results. The diagnosis of SIRS in the index study was mostly based on a combination of abnormal temperature with respiratory rate >2SD above normal for age (85 %, n=172). A combination of abnormal temperature with leucocyte counts (37 %, n=74) and abnormal leucocyte counts with respiratory rate >2 SD above normal for age (38 %, n=76) also defined SIRS. Seventy four patients (37 %) fulfilled more than 2 SIRS criteria. Majority (46 %, n=94) of patients were in the age group of 1 to 6 y (Table 1). Acute exacerbation of bronchial asthma constituted the major chunk of noninfective SIRS (Table 2). 23.4 % of males and 22.9 % of females had SIRS. The gender distribution of patients in SIRS and No SIRS group was not significant (p 0.45). Similarly there was no gender difference among patients with sepsis (males: 18.8 %, females: 17.6 %, p >0.5). Sepsis was confirmed by isolation of microbial agent in 18 % (n=29). This included 19 positive blood culture, 5 positive urine cultures, one sputum positive acid fast bacilli (AFB), one positive PCR for mycobacterial TB in pleural fluid, one sputum positive for Klebsiella in necrotising pneumonia, two with positive blood as well as urine culture. The most common organism isolated was Staphylococcus aureus (n=9) followed by gram negative organisms (Klebsiella, E. coli, Enterococcus, non lactose fermenting E. coli (NLF), Citrobacter in that order). Focus of infection in majority was pulmonary (44 %) followed by abdomen and CNS (17.6 % each). Intravascular focus constituted 14.4 %.
Table 1 Age wise distribution of SIRS patients
Table 2 Etiology of non infective SIRS
Patient data was analysed using descriptive statistics. The prevalence of SIRS among hospitalised children was detected with 95 % CI. Comparison of means (duration of hospital stay, duration of antibiotic therapy) was done by using unpaired t- test. Comparison of proportions (mortality analysis among SIRS and non SIRS patients, gender distribution of SIRS/Sepsis) was done by using chi square test. The study data was analysed using Statistical Package for Social Sciences (SPSS).
Results
Age group
Number
Percentage
0 days to 1 wk 1 wk to 1 mo 1 mo to 1 y > 1 y to
