{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T03:19:13Z","timestamp":1792811953545,"version":"4.5.0"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T00:00:00Z","timestamp":1763078400000},"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. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This study aimed to determine the incidence of septic shock in hospitalized children with viral pneumonia, identify high-risk viral pathogens, and compare the clinical features between viral- and bacterial-associated septic shock cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective study on viral respiratory infections in children hospitalized with pneumonia at two hospitals between 2022 and 2024 was conducted, with logistic regression used to assess the pathogen-specific risks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 5,956 children with viral pneumonia, the incidence of septic shock was 1.06%, varying significantly by pathogen (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Influenza A (FluA) showed the highest incidence (3.70%) and was the strongest predictor of shock [odds ratio (OR)\u2009=\u20097.506], followed by respiratory syncytial virus (RSV) (2.24%; OR\u2009=\u20094.559). Compared to bacterial shock cases (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200946), viral shock cases showed higher respiratory failure\/acute respiratory distress syndrome (ARDS) rates (88.9% vs. 52.2%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001) but they had shorter hospital stays (17.3 vs. 24.2 days,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.026). FluA cases were more likely to have less infant involvement (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.023), more neurologic compromise (35.7% vs. 8.7%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.040), and develop refractory shock (42.9% vs. 8.7%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007) compared to bacterial cases. RSV showed higher respiratory failure (75.9% vs. 52.2%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.040) and lower coagulopathy (34.5% vs. 60.9%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.026) rates.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>FluA and RSV are the key viral pathogens that predispose pediatric pneumonia patients to septic shock. Rapid viral polymerase chain reaction testing enables early pathogen identification, facilitating antibiotic de-escalation when bacterial coinfection is unlikely and promoting precise, safe antimicrobial stewardship.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2025.1665453","type":"journal-article","created":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T06:22:27Z","timestamp":1763101347000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Viral-associated septic shock in pediatric pneumonia: a retrospective analysis of pathogen-specific risks and comparative clinical features with bacterial 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