Title KHÁNG SINH NHIỄM KHUẨN HUYẾT TRẺ EM.pdf ✅

Tỷ lệ mắc và tử vong www.hospitalpediatrics.org DOI:https://doi.org/10.1542/hpeds.2020-0174 Copyright © 2020 by the American Academy of Pediatrics 0.97–1.12]) but was higher in the Angus cohort (8.4% vs 7.6%; OR: 1.12 [95% CI: 1.06–1.18]). Mortality: Regression Analysis In the ICD-9-CM cohort, a binary regression analysis was performed, with mortality as an independent variable and calendar year of admission, septic shock, APR DRG SOI, use of mechanical ventilation or vasopressors, and discharge from children’s hospitals as dependent factors. Compared to 2006, the case-fatality rate from sepsis was lower in 2009 (OR: 0.860 [95% CI 0.792–0.935]) and 2012 (OR: 0.716 [95% CI: 0.657–0.781]). DISCUSSION This study is focused on sepsis in the nonneonatal pediatric population. The disease process, etiology, pathogenesis, and outcomes of sepsis in these patients differ substantially from neonates.23 The KID provides a large sample size and includes data from 4200 US community hospitals, and national estimates gave us an opportunity to evaluate .8 million nonneonatal hospital discharges.18 This is a larger sample size compared to the Public Health Information System (PHIS), which includes data from 45 children’s hospitals.24 Studies have revealed that mortality rates and other parameters, like medical complexity and LOS, differ between large teaching hospitals and smaller hospitals.25 Incidence There was an increase in the incidence and decrease in the case-fatality rate from severe sepsis and septic shock during the study period by using both the ICD-9-CM and modified Angus criteria. As expected, the incidence of sepsis was higher by using the modified Angus criteria compared to the ICD-9-CM criteria because the modified Angus method is a more sensitive method of identifying the patients with sepsis.26 However, the sepsis case-fatality rate was higher when ICD-9-CM specific codes for severe sepsis and septic shock were used to identify sepsis. This suggests higher specificity but lower sensitivity in identifying patients with severe illness. The increase in the incidence and decrease in the sepsis case-fatality rate is similar to the other published pediatric sepsis studies.6,19 The increased incidence of sepsis may be due to a true increase in sepsis incidence or due to changes in coding and/or documentation practices or a combination of both. The increased incidence may be attributed to sicker patients being hospitalized, increased survival of patients with complex conditions, and improved sepsis detection. A recent study revealed increased prevalence of in- hospital cardiac arrests, suggesting an increased proportion of higher acuity patients being admitted to the US hospitals.27 However, the unchanged sepsis- associated mortality rate (per 10 000 total discharges) in the ICD-9-CM cohort and FIGURE 1 Sepsis case-fatality rate and incidence trends in ICD-9-CM cohort and Angus cohort. Incidence increased and mortality decreased from 2006 to 2012 (P , .01; Epi Info). FIGURE 2 Age-specific sepsis case-fatality rates in Angus cohort. The sepsis case-fatality rate in infants (10.2%) was significantly higher than other groups. P , .01 compared with other groups. 1024 SEHGAL et al Downloaded from http://publications.aap.org/hospitalpediatrics/article-pdf/10/12/1021/812892/hpeds_2020-0174.pdf by guest on 27 September 2023 8.830.057 trẻ em Mỹ, không kể sơ sinh