Neonatologist and Clinical Pharmacology Fellow University of Utah Salt Lake City, Utah, United States
Background: Pediatric sepsis is associated with significant mortality and morbidity. Broad-spectrum antibiotics are critical in treating the underlying disease. However, the choice of antibiotics varies and some antibiotics are associated with increased risk of mortality. For example, cefotaxime has been associated with an increased risk of mortality in neonatal populations even when adjusting for the severity of illness. It is not known if this association is also observed in older children or with other cephalosporins. Objective: The objective of this study is to determine if cephalosporin exposure is associated with increased an risk of mortality in pediatric sepsis. Design/Methods: We used the TriNetX database to perform a retrospective analysis of pediatric inpatient encounters with a diagnosis of sepsis. We compared rates of mortality between cases who were and were not exposed to a cephalosporin while controlling for the severity of illness. Risk of mortality will be assessed using multivariable logistic regression. Severity of illness will be assessed for each encounter by calculating a modified Pediatric Risk of Mortality (PRISM) III score. Further, mortality will be compared between cases who were and were not exposed to specific cephalosporins.
Preliminary data suggests that between December 2002 and April 2021, there were 820 inpatient pediatric encounters with a diagnosis of sepsis. Eighty-five percent (697/820) of encounters included exposure to a cephalosporin. Observed mortality among sepsis encounters in the cephalosporin exposed group was 10.3% (72/697) and 13.8% (17/123) in the non-exposed group. The 820 encounters were comprised of 724 patients with 67 patients having had more than one encounter. Ninety-two percent (668/724) of patients received a cephalosporin at an encounter, and 15.8% (106/668) of these patients died. Adjusted regression analyses investigating the association between cephalosporin use and mortality are ongoing and expected to be completed in November 2023.
