Clinical Risk Factors Of Poor Outcomes In Children With Streptococcus Pneumoniae Sepsis

Objective: To investigate the risk factors of poor outcomes in children with Streptococcus pneumoniae(S.pneumoniae)sepsis.Methods: This retrospective study enrolled children with S.pneumoniae sepsis who presented to the Children's Hospital of Chongqing Medical University from May 2011 to December 2018.Receiver-operating characteristic(ROC)analysis was used to identify the time to positivity(TTP)cutoff value.Classification and regression tree(CART)analysis was used to determine the time to appropriate therapy(TTAT)breakpoint.Logistic regression analyses were used to determine the risk factors.Results: During the study period,172 patients were included.The TTP was 12 hours and the CART-derived TTAT breakpoint was 13.6 hours.After adjustment for confounding factors,TTP?12 hours was found to be an independent predictor of sepsis-related in-hospital mortality(odds ratio[OR] 15.62;95% confidence interval [CI] 2.66-91.88)and septic shock(OR 4.02;95% CI 1.65-9.75).TTAT?13.6 hours was a risk factor of sepsis-related in-hospital mortality(OR 39.26;95%CI 6.10-252.60),septic shock(OR 4.58;95% CI 1.89-11.14)and requiring mechanical ventilation(OR 2.70;95% CI 1.01-7.35).Conclusion: Early TTP(TTP?12 hours)and delayed antibiotic therapy(TTAT?13.6)were associated with poor outcomes in children withS.pneumoniae sepsis.The optimal empiric antibiotic administration time window in children with S.pneumoniae sepsis was within 13.6 hours.