{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T06:43:37Z","timestamp":1775889817752,"version":"3.50.1"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:sec>\n            <jats:title>Introduction:<\/jats:title>\n            <jats:p>It is important for clinicians to recognize the contribution of toxic shock syndrome (TSS) to the overall burden of pediatric septic shock because the clinical features, optimal therapy and prognosis differ from non-TSS septic shock.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>We analyzed cases of pediatric septic shock reported to the Pediatric Health Information Systems database between 2009 and 2013 to define the clinical and demographic characteristics of pediatric TSS in the United States. Using a validated International Classification of Diseases, 9th revision, coding strategy, we identified patients with infectious shock among inpatients age 1\u201318 years and classified cases of staphylococcal and streptococcal TSS for comparison with non-TSS cases.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>Of 8,226 cases of pediatric septic shock, 909 (11.1%) were classified as TSS and 562 (6.8%) were possible TSS cases. Staphylococcal TSS represented the majority (83%) of TSS cases and occurred more commonly in females and at an older age. Compared with non-TSS septic shock, TSS had significantly lower fatality rates, disease severity and length of hospital stay and was present more often at the time of admission (<jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.001 for each). Streptococcal TSS was associated with poorer outcomes than staphylococcal TSS. Treatment for TSS differed from non-TSS septic shock in use of more clindamycin, vancomycin and Intravenous Immunoglobulin and less need for vasopressors.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Results demonstrate a significant contribution of TSS to the burden of pediatric septic shock in the United States. The findings emphasize the importance of inclusion of TSS diagnostic and therapeutic considerations in sepsis treatment protocols for children.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/inf.0000000000002002","type":"journal-article","created":{"date-parts":[[2018,3,29]],"date-time":"2018-03-29T21:33:42Z","timestamp":1522359222000},"page":"1223-1226","source":"Crossref","is-referenced-by-count":23,"title":["Epidemiology and Clinical Relevance of Toxic Shock Syndrome in US Children"],"prefix":"10.1097","volume":"37","author":[{"given":"James T.","family":"Gaensbauer","sequence":"first","affiliation":[{"name":"Pediatrics and Infectious Diseases, Denver Health Medical Center, Denver, Colorado"},{"name":"Pediatric Infectious Diseases, University of Colorado School of Medicine and Children\u2019s Hospital Colorado, Aurora, Colorado"},{"name":"Epidemiology, Children\u2019s Hospital Colorado, Denver, Colorado"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meghan","family":"Birkholz","sequence":"additional","affiliation":[{"name":"Epidemiology, Children\u2019s Hospital Colorado, Denver, Colorado"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael A.","family":"Smit","sequence":"additional","affiliation":[{"name":"Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roger","family":"Garcia","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Medicine, Denver Health Medical Center, Denver, Colorado."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James K.","family":"Todd","sequence":"additional","affiliation":[{"name":"Pediatric Infectious Diseases, University of Colorado School of Medicine and Children\u2019s Hospital Colorado, Aurora, Colorado"},{"name":"Epidemiology, Children\u2019s Hospital Colorado, Denver, Colorado"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R1-20230912","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1097\/PCC.0000000000000254","article-title":"Pediatric severe sepsis: current trends and outcomes from the Pediatric Health Information Systems database.","volume":"15","author":"Ruth","year":"2014","journal-title":"Pediatr Crit Care Med"},{"key":"R2-20230912","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1097\/CCM.0b013e31827e83af","article-title":"Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012.","volume":"41","author":"Dellinger","year":"2013","journal-title":"Crit Care Med"},{"key":"R3-20230912","doi-asserted-by":"crossref","first-page":"11","DOI":"10.2165\/00148581-200507010-00002","article-title":"Toxic shock syndrome in children: epidemiology, pathogenesis, and management.","volume":"7","author":"Chuang","year":"2005","journal-title":"Paediatr Drugs"},{"key":"R4-20230912","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1016\/j.jpeds.2015.09.027","article-title":"Identifying pediatric severe sepsis and septic shock: accuracy of diagnosis codes.","volume":"167","author":"Balamuth","year":"2015","journal-title":"J Pediatr"},{"key":"R5-20230912","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1097\/PCC.0b013e3182917fad","article-title":"Trends in the epidemiology of pediatric severe sepsis*.","volume":"14","author":"Hartman","year":"2013","journal-title":"Pediatr Crit Care Med"},{"key":"R6-20230912","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1164\/rccm.200207-682OC","article-title":"The epidemiology of severe sepsis in children in the United States.","volume":"167","author":"Watson","year":"2003","journal-title":"Am J Respir Crit Care Med"},{"key":"R7-20230912","doi-asserted-by":"crossref","first-page":"1855","DOI":"10.3201\/eid1011.121547","article-title":"Infectious shock and toxic shock syndrome diagnoses in hospitals, Colorado, USA.","volume":"19","author":"Smit","year":"2013","journal-title":"Emerg Infect Dis"},{"key":"R9-20230912","doi-asserted-by":"crossref","first-page":"e22997","DOI":"10.1371\/journal.pone.0022997","article-title":"Staphylococcal toxic shock syndrome 2000-2006: epidemiology, clinical features, and molecular characteristics.","volume":"6","author":"DeVries","year":"2011","journal-title":"PLoS One"},{"key":"R11-20230912","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1016\/S0140-6736(78)92274-2","article-title":"Toxic-shock syndrome associated with phage-group-I Staphylococci.","volume":"2","author":"Todd","year":"1978","journal-title":"Lancet"},{"key":"R12-20230912","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1093\/oxfordjournals.aje.a114167","article-title":"Toxic shock syndrome. 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