Objective: To describe the definitions for sepsis proposed by ACCP/SCCM Consensus Conference and to evaluate its capacity to classify children with severe meningococcal infection in homogeneous risk groups.
Methods: Eighty children with acute meningococcal infection and severe sepsis or septic shock, admitted to the pediatric ICU during a ten years period were reviewed. Mean age: 38 months (1,3 mo-14 yrs).
Results: N. meningitidis was isolated in 84%. Sixty-four percent of the patients were bacteremic and 39% showed a positive culture in CSF. Overall mortality was 19%. Fifty-two patients (65%) were in severe sepsis on admission, fifteen of them (29%) developed shock, mortality for this group was 4%. Twenty-eight patients (35%) were in septic shock on admission, mortality was 44%. Overall mortality of the shock group was 35%, mortality of shock on admission was higher than mortality of shock postadmission (44% vs 13%, p = 0.0001). Major complications were: DIC (28%), ARDS (26%), purpura fulminans (21%). There were not major complications or deaths in patients who did not develop shock. Bacteremia was not significant associated with shock or death. Meningitis was more frequent in severe sepsis group but 62% of deaths got it. Univariant analysis showed significant differences between both groups relative to tissular perfusion variables, coagulation and meningeal involvement. Multivariate analysis allowed us to establish a predictive model of survival feasible on admission to the ICU. For its determination three parameters are used: blood pressure, platelets and base excess.
Conclusion: Definitions proposed for severe sepsis and septic shock are a valuable tool to classify children with acute meningococcal infection in homogeneous risk groups.