{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:40:52Z","timestamp":1789432852537,"version":"build-2803163510"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,2,3]],"date-time":"2025-02-03T00:00:00Z","timestamp":1738540800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Bloodstream infection (BSI)-induced severe sepsis is a common cause of mortality, frequently resulting in septic shock and multiple organ dysfunction syndrome (MODS). This study aimed to analyze mortality risk factors and summarize pathogen characteristics associated with BSI-induced severe sepsis in the pediatric intensive care unit (PICU).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective study was conducted at a tertiary pediatric hospital between January 2015 and December 2023, encompassing children with BSI-induced severe sepsis in the PICU. Clinical characteristics, laboratory parameters, pathogen characteristics, and drug resistance profiles of the patients were collected. Clinical and laboratory indicators along with pathogen characteristics were summarized. Logistic regression analysis was employed to identify independent risk factors associated with 28-day mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 192 patients with bloodstream infection (BSI)-induced severe sepsis were identified, with a 28-day in-hospital mortality rate of 36.98% (71\/192). The incidence of septic shock (42.1% <jats:italic>vs<\/jats:italic>. 69%, P &amp;lt; 0.001) and AKI (14% <jats:italic>vs<\/jats:italic>. 31%, P = 0.005) was significantly lower in the survival group compared to the non-survival group. In multivariate analysis, independent risk factors for 28-day mortality were the pediatric sequential organ failure assessment (pSOFA) score (OR 1.176; 95% CI: 1.046-1.321, <jats:italic>p<\/jats:italic> = 0.007) and the P\/F value (OR 0.994; 95% CI: 0.991-0.997, <jats:italic>P &amp;lt;<\/jats:italic> 0.001). Double organism growth was detected in 8 cultures, and a total of 200 pathogenic bacteria were isolated from all blood cultures. Of these, 110 strains (55.0%) were Gram-negative bacteria, 88 strains (44.0%) were gram-positive bacteria, and 2 strains (1.0%) were <jats:italic>Candida albicans<\/jats:italic>. The most commonly isolated pathogens were <jats:italic>Staphylococcus aureus, Coagulase-negative Staphylococcus, and Escherichia coli<\/jats:italic>. The detection rate of carbapenem resistance (CR) in <jats:italic>Acinetobacter baumannii<\/jats:italic> (66.7%) was higher than that in <jats:italic>Pseudomonas aeruginosa<\/jats:italic> (15.4%). The detection rates of extended-spectrum cephalosporin resistance (ECR) and fluoroquinolone resistance (FQR) in <jats:italic>Escherichia coli<\/jats:italic> (<jats:italic>E. coli<\/jats:italic>) were higher than those in <jats:italic>Klebsiella pneumoniae<\/jats:italic>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In the PICU, higher mortality was observed in children with BSI-induced severe sepsis who presented with elevated pSOFA scores and low P\/F values. <jats:italic>Acinetobacter baumannii<\/jats:italic> exhibited the highest levels of CR and FQR, while <jats:italic>Escherichia coli<\/jats:italic> demonstrated the highest level of ECR.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcimb.2025.1492208","type":"journal-article","created":{"date-parts":[[2025,2,3]],"date-time":"2025-02-03T06:33:35Z","timestamp":1738564415000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":14,"title":["Risk factors associated with mortality and pathogen characteristics of bloodstream infection-induced severe sepsis in the pediatric intensive care unit: a retrospective cohort study"],"prefix":"10.3389","volume":"15","author":[{"given":"Jian","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haixin","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruichen","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yueqiang","family":"Fu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunmei","family":"Jing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,2,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1016\/s2352-4642(17)30010-x","article-title":"Epidemiology of blood culture-proven bacterial sepsis in children in Switzerland: a population-based cohort study","volume":"1","author":"Agyeman","year":"2017","journal-title":"Lancet Child Adolesc. Health"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e1004199","DOI":"10.1371\/journal.pmed.1004199","article-title":"The impact of inpatient bloodstream infections caused by antibiotic-resistant bacteria in low- and middle-income countries: A systematic review and meta-analysis","volume":"20","author":"Allel","year":"2023","journal-title":"PloS Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"860","DOI":"10.1111\/1469-0691.12028","article-title":"The changing epidemiology of bacteraemias in Europe: trends from the European Antimicrobial Resistance Surveillance System","volume":"19","author":"de Kraker","year":"2013","journal-title":"Clin. Microbiol. Infect."},{"key":"B4","doi-asserted-by":"publisher","first-page":"198","DOI":"10.3760\/cma.j.cn112137-20230729-00115","article-title":"Pathogenic characteristics and influence factors of bloodstream infection-induced severe sepsis in pediatric intensive care unit","volume":"104","author":"Dou","year":"2024","journal-title":"Zhonghua. Yi. Xue. Za. Zhi."},{"key":"B5","doi-asserted-by":"publisher","first-page":"e0028321","DOI":"10.1128\/Spectrum.00283-21","article-title":"Bacterial epidemiology and antimicrobial resistance profiles in children reported by the ISPED program in China 2016 to 2020","volume":"9","author":"Fu","year":"2021","journal-title":"Microbiol. Spectr."},{"key":"B6","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1097\/01.Pcc.0000149131.72248.E6","article-title":"International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics","volume":"6","author":"Goldstein","year":"2005","journal-title":"Pediatr. Crit. Care Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"e1525","DOI":"10.1542\/peds.2013-3795","article-title":"Attributable cost and length of stay for central line-associated bloodstream infections","volume":"133","author":"Goudie","year":"2014","journal-title":"Pediatrics"},{"key":"B8","doi-asserted-by":"publisher","first-page":"2560","DOI":"10.3201\/eid2710.204826","article-title":"Population-based study of bloodstream infection incidence and mortality rates, Finland 2004-2018","volume":"27","author":"Kontula","year":"2021","journal-title":"Emerg. Infect. Dis."},{"key":"B9","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1080\/23744235.2020.1727948","article-title":"Defining microbial invasion of the bloodstream: a structured review","volume":"52","author":"Laupland","year":"2020","journal-title":"Infect. Dis. (Lond)."},{"key":"B10","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1186\/s13756-022-01122-x","article-title":"Sepsis: emerging pathogens and antimicrobial resistance in Ethiopian referral hospitals","volume":"11","author":"Legese","year":"2022","journal-title":"Antimicrobial. Resistance. Infect. Control."},{"key":"B11","doi-asserted-by":"publisher","first-page":"e157","DOI":"10.1016\/s2214-109x(17)30007-4","article-title":"Causes and outcomes of sepsis in southeast Asia: a multinational multicentre cross-sectional study","volume":"5","author":"Limmathurotsakul","year":"2017","journal-title":"Lancet Global Health"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2018.02147","article-title":"Epidemiology and immune pathogenesis of viral sepsis","volume":"9","author":"Lin","year":"2018","journal-title":"Front. Immunol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1097\/pcc.0000000000000978","article-title":"New or progressive multiple organ dysfunction syndrome in pediatric severe sepsis: A sepsis phenotype with higher morbidity and mortality","volume":"18","author":"Lin","year":"2017","journal-title":"Pediatr. Crit. Care Med."},{"key":"B14","doi-asserted-by":"publisher","first-page":"6297","DOI":"10.2147\/idr.S426000","article-title":"Bacterial etiology and antimicrobial resistance pattern of pediatric bloodstream infections in Beijing 2015-2019","volume":"16","author":"Lyu","year":"2023","journal-title":"Infect. Drug Resistance."},{"key":"B15","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1016\/s2352-4642(18)30113-5","article-title":"Life-threatening infections in children in Europe (the EUCLIDS Project): a prospective cohort study","volume":"2","author":"Martin\u00f3n-Torres","year":"2018","journal-title":"Lancet Child Adolesc. Health"},{"key":"B16","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1093\/cid\/civ308","article-title":"Comparative effectiveness of beta-lactams versus vancomycin for treatment of methicillin-susceptible Staphylococcus aureus bloodstream infections among 122 hospitals","volume":"61","author":"McDanel","year":"2015","journal-title":"Clin. Infect. Dis."},{"key":"B17","doi-asserted-by":"publisher","first-page":"979","DOI":"10.1001\/jamapediatrics.2016.1477","article-title":"Epidemiology and mortality of staphylococcus aureus bacteremia in Australian and New Zealand children","volume":"170","author":"McMullan","year":"2016","journal-title":"JAMA Pediatr."},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020-0134","article-title":"Clinical management of staphylococcus aureus bacteremia in neonates, children, and adolescents","volume":"146","author":"McMullan","year":"2020","journal-title":"Pediatrics"},{"key":"B19","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1016\/j.anpedi.2019.05.018","article-title":"Paediatric sequential organ failure assessment (pSOFA) score: A new mortality prediction score in the paediatric intensive care unit","volume":"92","author":"Mohamed El-Mashad","year":"2020","journal-title":"Pediatr. (Engl. Ed)."},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics13020123","article-title":"Bloodstream infection in the intensive care unit: evolving epidemiology and microbiology","volume":"13","author":"Munro","year":"2024","journal-title":"Antibiot. (Basel. Switzerland)."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1073","DOI":"10.1586\/14787210.2015.1063418","article-title":"Bacteremia in children: epidemiology, clinical diagnosis and antibiotic treatment","volume":"13","author":"Pai","year":"2015","journal-title":"Expert Rev. Anti-infect. Ther."},{"key":"B22","doi-asserted-by":"publisher","first-page":"R202","DOI":"10.1186\/cc12896","article-title":"Characteristics and outcomes of culture-negative versus culture-positive severe sepsis","volume":"17","author":"Phua","year":"2013","journal-title":"Crit. Care (London. England)."},{"key":"B23","doi-asserted-by":"publisher","first-page":"891","DOI":"10.1080\/14787210.2023.2237192","article-title":"SIRS, SOFA, qSOFA, and NEWS in the diagnosis of sepsis and prediction of adverse outcomes: a systematic review and meta-analysis","volume":"21","author":"Qiu","year":"2023","journal-title":"Expert Rev. Anti-infect. Ther."},{"key":"B24","doi-asserted-by":"publisher","first-page":"e187571","DOI":"10.1001\/jamanetworkopen.2018.7571","article-title":"Prevalence, underlying causes, and preventability of sepsis-associated mortality in US acute care hospitals","volume":"2","author":"Rhee","year":"2019","journal-title":"JAMA Netw. Open"},{"key":"B25","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1016\/s0140-6736(19)32989-7","article-title":"Global, regional, and national sepsis incidence and mortality 1990-2017: analysis for the global burden of disease study","volume":"395","author":"Rudd","year":"2020","journal-title":"Lancet (London. England)."},{"key":"B26","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1001\/jama.2016.0289","article-title":"Developing a new definition and assessing new clinical criteria for septic shock: for the third international consensus definitions for sepsis and septic shock (Sepsis-3)","volume":"315","author":"Shankar-Hari","year":"2016","journal-title":"Jama"},{"key":"B27","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The third international consensus definitions for sepsis and septic shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics11030362","article-title":"Use of antimicrobials for bloodstream infections in the intensive care unit, a clinically oriented review","volume":"11","author":"Tabah","year":"2022","journal-title":"Antibiot. (Basel. Switzerland)."},{"key":"B29","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1007\/s00134-020-05950-6","article-title":"Bloodstream infections in critically ill patients: an expert statement","volume":"46","author":"Timsit","year":"2020","journal-title":"Intensive Care Med."},{"key":"B30","doi-asserted-by":"publisher","first-page":"814","DOI":"10.1097\/pcc.0000000000000247","article-title":"An epidemiologic survey of pediatric sepsis in regional hospitals in China","volume":"15","author":"Wang","year":"2014","journal-title":"Pediatr. Crit. Care Med."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1147","DOI":"10.1164\/rccm.201412-2323OC","article-title":"Global epidemiology of pediatric severe sepsis: the sepsis prevalence, outcomes, and therapies study","volume":"191","author":"Weiss","year":"2015","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"B32","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1007\/s00134-019-05878-6","article-title":"Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children","volume":"46","author":"Weiss","year":"2020","journal-title":"Intensive Care Med."},{"key":"B33","unstructured":"Global report on the epidemiology and burden of sepsis: Current evidence, identifying gaps and future directions\n          \n          \n          \n          2020"},{"key":"B34","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1016\/s1473-3099(16)30517-5","article-title":"Health-care-associated infections in neonates, children, and adolescents: an analysis of paediatric data from the European Centre for Disease Prevention and Control point-prevalence survey","volume":"17","author":"Zingg","year":"2017","journal-title":"Lancet Infect. Dis."}],"container-title":["Frontiers in Cellular and Infection Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2025.1492208\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,3]],"date-time":"2025-02-03T06:33:39Z","timestamp":1738564419000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2025.1492208\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,3]]},"references-count":34,"alternative-id":["10.3389\/fcimb.2025.1492208"],"URL":"https:\/\/doi.org\/10.3389\/fcimb.2025.1492208","relation":{},"ISSN":["2235-2988"],"issn-type":[{"value":"2235-2988","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,3]]},"article-number":"1492208"}}