Objective: To describe characteristics of liver transplant patients with severe sepsis in the pediatric intensive care unit (PICU) Design: Retrospective descriptive analysis Setting: Tertiary children's hospital PICU Patients: Liver transplant recipients admitted Jan 2010 to Jul 2016 for pediatric severe sepsis Interventions: None Measurements and Main Results: Between Jan 2010-Jul 2016, 173 liver transplants were performed, and 36 of these patients (21%) were admitted with severe sepsis (54 episodes total). Median age at admission was 2 y [1-6.5 y], 47.2% were male. Bacterial infections were the most common (77.8%), followed by culture negative (12.9%) and viral infections (7.4%). Fungal infections accounted for only 1.9%. Median time from transplant for viral and culture negative infections was 18 d [8.25-39.75 d] and 25 d [9-41 d], while 54.5 d [17-131.25 d] for bacterial infections. Bloodstream and intra-abdominal were the most common bacterial sites (45% and 22.5%, respectively). Multidrug-resistant organisms (MDROs) accounted for 47.6% of bacterial sepsis. Vancomycin resistant enterococcus and extended spectrum beta-lactamase producers were the most frequently identified MDROs. Patients with MDRO sepsis demonstrated higher admission PELOD scores (P=0.043) and were noted to have an odds ratio of 3.8 and 3.6 for mechanical ventilation and MODS, respectively (P=0.047 and P=0.044). Overall mortality was 5.5% (n=2 patients), with both deaths occurring in MDRO episodes.
Background:Sepsis kills almost 5,000 children annually, accounting for 16% of pediatric health care spending in the United States.Objectives:We sought to identify sepsis within the Electronic Health Record (EHR) of a quaternary children’s hospital to characterize disease incidence, improve recognition and response, and track performance metrics.Methods:Methods are organized in a plan-do-study-act cycle. During the “plan” phase, electronic definitions of sepsis (blood culture and antibiotic within 24 hours) and septic shock (sepsis plus vasoactive medication) were created to establish benchmark data and track progress with statistical process control. The performance of a screening tool was evaluated in the emergency department. During the “do” phase, a novel inpatient workflow is being piloted, which involves regular sepsis screening by nurses using the tool, and a regimented response to high risk patients.Results:Screening tool use in the emergency department reduced time to antibiotics (Fig. 1). Of the 6,159 admissions, EHR definitions identified 1,433 (23.3%) between July and December 2016 with sepsis, of which 159 (11.1%) had septic shock. Hospital mortality for all sepsis patients was 2.2% and 15.7% for septic shock (Table 1). These findings approximate epidemiologic studies of sepsis and severe sepsis, which report a prevalence range of 0.45–8.2% and mortality range of 8.2–25% (Table 2).1–5Conclusions/Implications:Implementation of a sepsis screening tool is associated with improved performance. The prevalence of sepsis conditions identified with electronic definitions approximates the epidemiologic landscape characterized by other point-prevalence and administrative studies, providing face validity to this approach, and proving useful for tracking performance improvement.
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