Childhood sepsis burden: pathogens/antimicrobial-resistant bacteria, 1990-2021 and 2050 forecasts.

BACKGROUND

To assess the global burden and trends of childhood sepsis, and to evaluate whether clarifying these aspects can provide a basis for formulating targeted prevention and treatment strategies for the condition.

METHODS

Using the Global Burden of Disease (GBD) 2021 database, we analyzed sepsis in 0-14-year-olds, covering 62 pathogens (21 drug-resistant), 84 "pathogen-drug" combinations, 12 infection syndromes, and indicators (deaths, disability-adjusted life years [DALYs], age-standardized rates). Antimicrobial resistance (AMR) was defined by two counterfactual scenarios; an autoregressive integrated moving average (ARIMA) model forecast AMR-related sepsis to 2050.

RESULTS

From 1990 to 2021, global sepsis-related deaths among children declined from 6.43 million to 2.24 million, and DALYs dropped from 578 million to 203 million. The estimated annual percentage change (EAPC) in age-standardized mortality rate (ASMR) and DALY rate (ASDR) was -3.35 and -3.33, respectively. AMR-related sepsis burden also decreased, with notable declines in both AMR-associated and AMR-attributable deaths and DALYs. In 2021, the highest burden remained in Sub-Saharan Africa, while the lowest was in High-income regions. Leading pathogens causing child sepsis deaths included Streptococcus pneumoniae, Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa. Bloodstream infections, lower respiratory infections, and diarrhea were the most common infection syndromes leading to sepsis-related deaths.

CONCLUSION

Global childhood sepsis burden dropped, but high-burden regions (e.g., Sub-Saharan Africa, South Asia) need focus. Future efforts should optimize healthcare, strengthen AMR control, promote vaccination, and improve sanitation.