Comparison between hospital- and community-acquired septic shockin children: a single-center retrospective cohort study

Background We explored the differences in baseline characteristics, pathogens, complications, outcomes, and risk factorsbetween children with hospital-acquired septic shock (HASS) and community-acquired septic shock (CASS) in the pediatricintensive care unit (PICU).Methods This retrospective study enrolled children with septic shock at the PICU of Beijing Children’s Hospital from January1, 2016, to December 31, 2019. The patients were followed up until 28 days after shock or death and were divided intothe HASS and CASS group. Logistic regression analysis was used to identify risk factors for mortality.Results A total of 298 children were enrolled. Among them, 65.9% (n = 91) of HASS patients had hematologic/oncologicdiseases, mainly with Gram-negative bacterial bloodstream infections (47.3%). Additionally, 67.7% (n = 207) of CASSpatients had no obvious underlying disease, and most experienced Gram-positive bacterial infections (30.9%) of the respiratoryor central nervous system. The 28-day mortality was 62.6% and 32.7% in the HASS and CASS groups, respectively(P < 0.001). Platelet [odds ratio (OR) = 0.996, 95% confidence interval (CI) = 0.992–1.000, P = 0.028], positive pathogendetection (OR = 3.557, 95% CI = 1.307–9.684, P = 0.013), and multiple organ dysfunction syndrome (OR = 10.953, 95%CI = 1.974–60.775, P = 0.006) were risk factors for 28-day mortality in HASS patients. Lactate (OR = 1.104, 95% CI = 1.022–1.192, P = 0.012) and mechanical ventilation (OR = 8.114, 95% CI = 1.806–36.465, P = 0.006) were risk factors for 28-daymortality in patients with CASS.Conclusions The underlying diseases, pathogens, complications, prognosis, and mortality rates varied widely between theHASS and CASS groups. The predictors of 28-day mortality were different between HASS and CASS pediatric patientswith septic shock.