The burden of invasive infections in critically ill Indigenous children in Australia.
OBJECTIVE
To describe the incidence and mortality of invasive infections in Indigenous children admitted to paediatric and general intensive care units (ICUs) in Australia.


METHODS
Retrospective multi-centre cohort study of Australian and New Zealand Paediatric Intensive Care Registry data.


METHODS
All children under 16 years of age admitted to an ICU in Australia, 1 January 2002 - 31 December 2013. Indigenous children were defined as those identified as Aboriginal and/or Torres Strait Islander in a mandatory admissions dataset.


RESULTS
Population-based ICU mortality and admission rates.


RESULTS
Invasive infections accounted for 23.0% of non-elective ICU admissions of Indigenous children (726 of 3150), resulting in an admission rate of 47.6 per 100 000 children per year. Staphylococcus aureus was the leading pathogen identified in children with sepsis/septic shock (incidence, 4.42 per 100 000 Indigenous children per year; 0.57 per 100 000 non-Indigenous children per year; incidence rate ratio 7.7; 95% CI, 5.8-10.1; P < 0.001). While crude and risk-adjusted ICU mortality related to invasive infections was not significantly different for Indigenous and non-Indigenous children (odds ratio, 0.75; 95% CI, 0.53-1.07; P = 0.12), the estimated population-based age-standardised mortality rate for invasive infections was significantly higher for Indigenous children (2.67 per 100 000 per year v 1.04 per 100 000 per year; crude incidence rate ratio, 2.65; 95% CI, 1.88-3.64; P < 0.001).


CONCLUSIONS
The ICU admission rate for severe infections was several times higher for Indigenous than for non-Indigenous children, particularly for S. aureus infections. While ICU case fatality rates were similar, the population-based mortality was more than twice as high for Indigenous children. Our study highlights an important area of inequality in health care for Indigenous children in a high income country that needs urgent attention.
Mater Research Institute, University of Queensland, Brisbane, QLD l.schlapbach@uq.edu.au.
Justyna A
JA
Ostrowski
University of Melbourne, Melbourne, VIC.
Graeme
G
MacLaren
Australian and New Zealand Paediatric Intensive Care Registry (CORE), Brisbane, QLD.
Janet
J
Alexander
Alice Springs Hospital, Alice Springs, NT.
Penny
P
Stewart
Alice Springs Hospital, Alice Springs, NT.
Sheena
S
Gune
Royal Darwin Hospital, Darwin, NT.
Joshua R
JR
Francis
Women's and Children's Hospital Adelaide, Adelaide, SA.
Subodh
S
Ganu
Children's Hospital at Westmead, Sydney, NSW.
Marino
M
Festa
Princess Margaret Hospital for Children, Perth, WA.
Simon J
SJ
Erickson
Monash University, Melbourne, VIC.
Lahn
L
Straney
Mater Research Institute, University of Queensland, Brisbane, QLD.
Luregn J
LJ
Schlapbach
D000293:Adolescent; D001315:Australia / Q000453:epidemiology / Q000208:ethnology; D002648:Child; D002673:Child, Hospitalized / Q000706:statistics & numerical data; D002675:Child, Preschool; D015331:Cohort Studies; D017281:Cost of Illness; D000066891:Critical Care Outcomes; D016638:Critical Illness / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D009026:Mortality; D009520:New Zealand / Q000453:epidemiology / Q000208:ethnology; D044382:Population Groups / Q000208:ethnology; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology* / Q000401:mortality; D012720:Severity of Illness Index; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology; D013211:Staphylococcus aureus / Q000302:isolation & purification; D016019:Survival Analysis