title: Infectious Etiologies and Patient Outcomes in Pediatric Septic Shock.
abstract: BACKGROUND
  Septic shock remains an important cause of death and disability in children. Optimal care requires early recognition and treatment.
  
  
  METHODS
  We evaluated a retrospective cohort of children (age <19) treated in our emergency department (ED) for septic shock during 2008-2012 to investigate the association between timing of antibiotic therapy and outcomes. The exposures were (1) receipt of empiric antibiotics in ≤1 hour and (2) receipt of appropriate antibiotics in ≤1 hour. The primary outcome was development of new or progressive multiple system organ dysfunction syndrome (NP-MODS). The secondary outcome was mortality.
  
  
  RESULTS
  Among 321 patients admitted to intensive care, 48% (n = 153) received empiric antibiotics in ≤1 hour. These patients were more ill at presentation with significantly greater median pediatric index of mortality 2 (PIM2) scores and were more likely to receive recommended resuscitation in the ED (61% vs 14%); however, rates of NP-MODS (9% vs 12%) and hospital mortality (7% vs 4%) were similar to those treated later. Early, appropriate antibiotics were administered to 33% (n = 67) of patients with identified or suspected bacterial infection. These patients had significantly greater PIM2 scores but similar rates of NP-MODS (15% vs 15%) and hospital mortality (10% vs 6%) to those treated later.
  
  
  CONCLUSIONS
  Critically ill children with septic shock treated in a children's hospital ED who received antibiotics in ≤1 hour were significantly more severely ill than those treated later, but they did not have increased risk of NP-MODS or death.
authors.affiliation: Department of Pediatrics.
authors.forename: Stefanie G
authors.initials: SG
authors.lastname: Ames
authors.affiliation: Division of Critical Care, Department of Pediatrics.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Workman
authors.affiliation: Department of Pharmacy.
authors.forename: Jared A
authors.initials: JA
authors.lastname: Olson
authors.affiliation: Pediatric Clinical Program, Intermountain Healthcare, Salt Lake City, Utah.
authors.forename: E Kent
authors.initials: EK
authors.lastname: Korgenski
authors.affiliation: System Improvement, Primary Children's Hospital.
authors.forename: Susan
authors.initials: S
authors.lastname: Masotti
authors.affiliation: Division of Infectious Disease, Department of Pediatrics, University of Utah.
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Knackstedt
authors.affiliation: Division of Critical Care, Department of Pediatrics.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Bratton
authors.affiliation: Division of Critical Care, Department of Pediatrics.
authors.forename: Gitte Y
authors.initials: GY
authors.lastname: Larsen
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D061345:Early Medical Intervention; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012772:Shock, Septic / Q000188:drug therapy* / Q000401:mortality; D016019:Survival Analysis
chemical_list: D000900:Anti-Bacterial Agents
keywords: anti-bacterial agents; critical care; pediatrics; septic shock; severe sepsis