The study included 49 patients from 1 month to 15 years old who had diagnosis of septic shock and treated at ICU of the National Hospital of Paediatrics. The result showed that: group of age<5 years is 71.4%; The male/female ratio is 2.06/1. Patients admitted to hospital from April to June (42.8%). About 90% of cases have local infections such as respiratory infection (34.7%), gastrointestinal infection (24.5%), skin, musle and bone infections (22.4%). All of them have uncompensated shock with symptoms of poor tissue perfusion and hypodynamic; disorded status (100%); cool extremities (91.8%); refill>3 seconds (100%); drop blood pressure (69.4%); weak pulse (71.4%), oliguria and anuresis (100%) and CVP<5 cmH2O (51.2%)
Shock, Septic, Child, Diagnosis

Background: Septic shockis often seen in severe disease to be hospitalized at Intensive Care Unit. In America, there are about 400,000 infection cases in which 20% to 40% develop into septic sock. Objectives:This study aims to find out some prognostic factors of death in treatment of septic shock in children. Subjects and method:A prospective and descriptive study was conducted on 67 patients suffering from septic shock based on \u201cThe 2002 American College of Critical Care Medicine/Society of Critical Care Medicine \ufffd?combined with standard of 1993 National conference on Intensive care whom admitted Intensive care unit of National Hospital of Pediatrics (N.H.P) Results:The severity of shock affecting mortality rate [OR=33.0; 95% CI (6.6 - 163.0), P < 0.001]. The delay of shock diagnosis significantly affected the results of treatment and mortality rate [OR= 52.0; 95% CI (5.8 - 446.0); p < 0.001]. The severity of acidosis has affected on results of treatment and mortality rate [OR= 4.00; p<0.05]. The blood lactate of > 5.5 mmol/l indicated a bad prognosis and high mortality risk; Se 79%, Sp 52%, AUC 0.75%. The lactate level affected the mortality rate [OR = 10.0; 95% CI (1.9 - 62.0); p < 0.05]. Conclusion: The factors effected to the treatment results and mortality risk consisted of severe sock level, late diagnosis, infected severe high lactate concentration.
Shock ; Septic/ diagnosis ; mortality ; Child

Humans ; Infant, Newborn ; Shock, Septic ; diagnosis ; etiology ; therapy

Diagnosis and treatment criteria were recently updated based on the Sepsis-3 guidelines, which recommend the sequential organ failure assessment for accurate characterization of organ dysfunction. Large randomized controlled trials have found neutral results with early goal-directed therapy. To improve outcomes, treatment bundles incorporating standards for early sepsis treatment, including antibiotic and steroid treatment, were developed. Thus, future research should address the effects of steroids and immune-modulating agents on refractory septic shock as well as the development of new coagulopathy therapies and dynamic assessment tools.
Diagnosis ; Sepsis ; Shock, Septic ; Steroids ; Systemic Inflammatory Response Syndrome

Much has been learned of the pathogenesis and pathophysiology of the toxic shock syndrome (TSS) since the initial description in 1978 by Dr. James K, Todd. The clinical illness is defined by the criteria listed in the case definition formulated for epidemiologic studies. With the advent of widespread recognition of TSS, there have been numerous published reports describing the clinical and laboratory findings, primarily in menstruating females. And there have been also reported about six cases in Korea. Moreover, TSS is uncommon in the prepubertal age group and no case report in infant in Korea. We experienced two cases of TSS in infants aged 11/2 yrs and 9 months associated with respiratory infection-pneumonia, pyopneumothorax and localized skin abscess that were confused with Kawasaki disease (KD). The diagnosis was made on the basis of clinical features and laboratory findings, and the cases met the Centers of Disease Control case definition of TSS. And thus we report these cases and review related literatures.
Abscess ; Diagnosis ; Female ; Humans ; Infant* ; Korea ; Mucocutaneous Lymph Node Syndrome ; Shock, Septic* ; Skin

One of the most fearful rare complication of ureteroscopic lithotripsy is sepsis. Since sepsis after endourological maneuvers usually occur immediately after procedure, it is important to pay attention to symptoms representing sepsis such as pyrexia, tachycardia, tachypnea, and oliguria. In addition to clinical symptoms, laboratory tests including white blood cell (WBC) count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and urine and blood cultivating can help to diagnosis of sepsis. We present a case of shock after ureteroscopic lithotripsy, which was suspected with septic shock strongly.
Blood Sedimentation ; C-Reactive Protein ; Diagnosis ; Fever ; Leukocytes ; Lithotripsy* ; Oliguria ; Sepsis ; Shock* ; Shock, Septic ; Tachycardia ; Tachypnea

Streptococcal toxic shock syndrome with myonecrosis is a rapidly progressive process that kills 80% of patients in 72-96 h. Various bullae, hypotension, fever, and evidence of organ failure are late clinical manifestations. The symptoms and signs of myonecrosis can be nonspecific and misleading, not clearly revealing the involvement of deep skeletal muscle. Thus, the challenge to clinicians is to make an early diagnosis and to intervene with aggressive fluid replacement, emergent surgical debridement, and general supportive measures. We describe an presentation of myonecrosis of the lower extremities secondary to group A beta-hemolytic streptococcus infection in a 21-years-old woman. In addition, the patient had no history or evidence of trauma to the affected area.
Debridement ; Early Diagnosis ; Female ; Fever ; Humans ; Hypotension ; Lower Extremity ; Muscle, Skeletal ; Shock, Septic* ; Streptococcal Infections ; Streptococcus*

diagnosis. The exact pathogenesis is not well understood, however it is thought to be due to the effect of an enterotoxin produced by certain strains of staphylococcus aureus.]]>
Acute Disease ; Diagnosis ; Enterotoxins ; Exanthema ; Fever ; Hypotension ; Shock ; Shock, Septic ; Staphylococcus aureus

The management of sepsis and septic shock remains challenging. The aim is to apply the optimal antimicrobial therapy and antimicrobial stewardship to patients in state of sepsis or septic shock. To reduce the mortality of sepsis and septic shock, it is critical to promptly administer the appropriate antibiotics with an accurate diagnosis. De-escalation is needed 48 to 72 hours after the first administration of antibiotics depending on the findings of causative pathogens. In the case of antibiotic resistance, the importance of an antibiotic stewardship program is increasingly being emphasized. Antimicrobial stewardship implies coordinated interventions designed to improve the appropriate use of antibiotics by promoting the selection of an optimal drug regimen such as dosing, duration of therapy, and route of administration. An antibiotic stewardship program may also be applied to patients of both sepsis and septic shock. Efforts such as the selection of appropriate empirical antibiotics, de-escalation, and determination of whether to stop antibiotics with procalcitonin may improve the clinical prognosis of patients with sepsis as well as the successful implementation of an antibiotic stewardship program.
Anti-Bacterial Agents ; Anti-Infective Agents ; Diagnosis ; Drug Resistance, Microbial ; Humans ; Mortality ; Prognosis ; Sepsis ; Shock, Septic

Objective: To evaluate the clinical value of new coagulation biomarkers including soluble thrombomodulin (sTM) and tissue plasminogen activator inhibitor complex (t-PAI·C) for the diagnosis and prognosis of sepsis in children. Methods: The prospective observational study enrolled 59 children who were diagnosed with sepsis including severe sepsis and septic shock in the Department of Pediatric Critical Care Medicine of Shanghai Children's Medical Center affiliated to the Medical College of Shanghai Jiao Tong University from June 2019 to June 2021. The sTM, t-PAI·C and conventional coagulation tests were detected on illness day one of sepsis. Twenty healthy children were selected as the control group, and the above parameters were detected on the day of inclusion. Children with sepsis were divided into survival group and non-survival group according to prognosis at discharge. Baseline comparisons between groups were performed using Mann-Whitney U test. Multivariate Logistic regression analysis was used to evaluate the risk factors for the diagnosis and prognosis of sepsis in children. Receiver operating characteristic (ROC) curve was conducted to evaluate the predictive values of above variables for the diagnosis and prognosis of sepsis in children. Results: The sepsis group included 59 patients (39 boys and 20 girls), aged 61(22, 136)months. There were 44 patients in the survival group and 15 patients in the non-survival group, respectively. The control group consisted of 20 boys, aged 107 (94,122) months. Patients in the sepsis group had higher sTM and t-PAI·C ((12 (9, 17)×10³ vs. 9(8, 10)×10³ TU/L, 10(6, 22) vs. 2 (1, 3) μg/L, Z=-2.15, -6.05, both P<0.05) compared with children in the control group. The t-PAI·C was superior to sTM for the diagnosis of sepsis. The areas under the curve (AUC) of t-PAI·C and sTM for the diagnosis of sepsis were 0.95 and 0.66, respectively, and the optimal cut-off value were 3 μg/L and 12×10³ TU/L, respectively. Patients in the survival group had lower sTM (10 (8, 14)×10³ vs. 17 (11, 36)×10³ TU/L, Z=-2.73, P=0.006) than those in the non-survival group. Logistic regression analysis showed that sTM was a risk factor for death at discharge (OR=1.14, 95%CI 1.04-1.27, P=0.006). The AUC of sTM and t-PAI·C for predicting death at discharge were 0.74 and 0.62, respectively, and the optimal cut-off values were 13×10³ TU/L and 6 μg/L, respectively. The AUC of sTM combined with platelet counts for predicting death at discharge was 0.89, which was superior to sTM and t-PAI·C. Conclusion: The sTM and t-PAI·C had clinical application values in diagnosing and predicting prognosis in pediatric sepsis.
Child ; Female ; Humans ; Male ; Biomarkers ; China ; Sepsis/diagnosis* ; Shock, Septic ; Tissue Plasminogen Activator ; Infant ; Child, Preschool