Vaccine preventable infections and multiple organ dysfunction syndrome in critically ill children in China.
BACKGROUND
Multiple organ dysfunction syndrome (MODS) is a major cause of mortality in PICUs in industrialized countries. As developing countries become more advanced, PICU care comes into reach. The aim of this study was to examine MODS in a PICU in China in comparison with other countries.


METHODS
A retrospective 5-year audit (2001-2006) of MODS cases in a 6-bed PICU in the Second Hospital of Lanzhou University, China.


RESULTS
Of the 332 PICU patients, 176 (53%) had MODS; the mean age was 35 months, and 60% were <1 year of age. Infectious diseases were the predominant factor underlying MODS (128/176; 73%) with 24% attributable to potentially vaccine preventable infections (14 to Haemophilus influenzae b, 13 to Streptococcus pneumoniae, and 4 to Neisseria meningitidis). The case fatality rate for MODS was 49% with no difference between infectious or noninfectious causes (48% vs. 52%; P > 0.05). The frequency of organ dysfunction in MODS was in decreasing order: respiratory (95%), cardiovascular (89%), gastrointestinal (39%), neurologic (35%), hematologic (16%), renal (14%), and hepatic (4%) systems. Mortality rose with increasing number of organs involved. Gastrointestinal system failure was more common in MODS caused by infection than noninfection (45% vs. 23%; P <0.01) and had a higher mortality (72% vs. 34%; P < 0.001). The case fatality rate for MODS in this study was comparable to rates in other developing countries but higher than in industrialized countries.


CONCLUSIONS
MODS is a major cause of mortality in PICU patients in China. In China, infection-related MODS PICU cases could potentially be reduced to rates closer to those in industrialized countries, if conjugated H. influenzae b and conjugated pneumococcal vaccines were introduced into routine practice.
Zhang
Qing Li
QL
Department of Pediatrics, West China Second University Hospital, Sichuan University, Sichuan, China.
Wan
Chao Min
CM
MacDonald
Noni E
NE
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D016638:Critical Illness; D005260:Female; D006192:Haemophilus Infections / Q000150:complications / Q000382:microbiology / Q000517:prevention & control; D018073:Haemophilus Vaccines / Q000008:administration & dosage; D019741:Haemophilus influenzae type b; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D009102:Multiple Organ Failure / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D011008:Pneumococcal Infections / Q000150:complications / Q000382:microbiology / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000008:administration & dosage; D013296:Streptococcus pneumoniae
D018073:Haemophilus Vaccines; D022242:Pneumococcal Vaccines