Supportive care and in-hospital mortality among children with suspected sepsis in Bamako, Mali

Résumé

Introduction Sepsis causes significant pediatric hospitalizations and deaths globally. The impact of supportive care interventions remains under-studied in sub-Saharan Africa, where mortality is greatest. Methods We conducted a prospective cohort study of children under five years hospitalized with study-defined suspected invasive bacterial infection and ≥2 adapted systemic inflammatory response syndrome (SIRS) criteria at l'Hôpital Gabriel Touré (HGT), a tertiary care center in Bamako, Mali, between January 2021 and July 2024. Associations between supportive care therapies (antibiotics, intravenous fluids, and supplemental oxygen) and in-hospital mortality were evaluated using multivariable logistic regression and time-varying Cox proportional hazards models adjusted for prespecified demographic and clinical covariates. Results Among 1,569 enrolled children, 165 (10.5%) had a culture positive for a putative pathogen; 516 (32.9%) died during hospitalization. Most patients received antibiotics (86.4%), while 56.0% received intravenous fluids and 28.7% received supplemental oxygen. Antibiotics and intravenous fluids were not significantly associated with mortality after adjustment. Receipt of supplemental oxygen was associated with higher odds of in-hospital death (aOR: 2.09, 95% CI: 1.50, 2.91), an association potentially reflecting confounding by indication due to greater illness severity among children receiving oxygen. Conclusions In this observational cohort with high in-hospital mortality from suspected pediatric sepsis, supportive care therapies were not associated with improved survival after multivariable adjustment. These findings may reflect confounding by indication and a high burden of antimicrobial resistance that may limit the effectiveness of empiric antibiotic therapy. Reducing pediatric sepsis mortality in resource-limited settings will require improved access to microbiologically active antibiotics alongside context-appropriate pediatric critical care interventions.

Citer ce document

Accès au document

Texte intégral en lecture en ligne, réservé aux abonnés SPHAERO et aux membres de l'institution. Se connecter

Auteur(s)

Statistiques

Consultations : 1

Téléchargements : 0